School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia,
Support Care Cancer. 2014 Jul;22(7):1727-34. doi: 10.1007/s00520-014-2171-x. Epub 2014 Mar 2.
Polypharmacy has been associated with drug-drug interactions, adverse drug events, hospitalisation and increased mortality. The purpose of this study was to investigate the prevalence and factors associated with polypharmacy in older people with cancer.
Patients aged≥70 years (n=385) presenting to the medical oncology outpatient clinic at Royal Adelaide Hospital between January 2009 and July 2010 completed a structured data collection instrument. The instrument included domains related to medications, diagnoses, instrumental activities of daily living (IADLs), Karnofsky Performance Scale (KPS), physical function (SF-36), pain (ten-point visual analogue scale, VAS), weight loss (patient self-reported over previous 6 months), exhaustion (CES-D) and distress (ten-point VAS). Frailty was computed using Fried's frailty phenotype. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between polypharmacy (defined as five or more self-reported daily medications) and clinical parameters.
Polypharmacy was present in 57% (n=221) of patients. When adjusting for age, gender and Charlson Comorbidity Index (CCI), polypharmacy was associated with being pre-frail (OR=2.35, 95%CI=1.43-3.86) and frail (OR=4.48, 95%CI=1.90-10.54) compared to being robust. When adjusting for age, gender, exhaustion, KPS, IADLs, pain and distress, polypharmacy was associated with higher CCI scores (OR=1.58, 95%CI=1.29-1.94) and poorer physical function (OR=1.13, 95%CI=1.06-1.20).
Polypharmacy is highly prevalent in older people with cancer and associated with impaired physical function and being pre-frail and frail compared to being robust. Research is needed to identify strategies to minimize patients' medication regimens.
药物相互作用、药物不良事件、住院和死亡率的增加与多种药物治疗有关。本研究的目的是调查老年癌症患者中多种药物治疗的流行情况和相关因素。
2009 年 1 月至 2010 年 7 月期间，在阿德莱德皇家医院的医学肿瘤学门诊就诊的年龄≥70 岁的患者（n=385）完成了一项结构化数据采集工具。该工具包括与药物、诊断、工具性日常生活活动（IADLs）、卡诺夫斯基表现量表（KPS）、身体功能（SF-36）、疼痛（十分制视觉模拟量表，VAS）、体重减轻（患者自我报告过去 6 个月）、疲劳（CES-D）和痛苦（十分制 VAS）相关的领域。衰弱使用 Fried 的衰弱表型进行计算。使用逻辑回归计算未调整和调整后的优势比（OR）和 95%置信区间（CI），以评估多种药物治疗（定义为五种或更多种自我报告的日常药物）与临床参数之间的关联。
57%（n=221）的患者存在多种药物治疗。在调整年龄、性别和 Charlson 合并症指数（CCI）后，与身体强壮相比，衰弱（OR=2.35，95%CI=1.43-3.86）和虚弱（OR=4.48，95%CI=1.90-10.54）与多种药物治疗相关。在调整年龄、性别、疲劳、KPS、IADLs、疼痛和痛苦后，多种药物治疗与更高的 CCI 评分（OR=1.58，95%CI=1.29-1.94）和较差的身体功能（OR=1.13，95%CI=1.06-1.20）相关。
老年癌症患者中多种药物治疗非常普遍，与身体虚弱和虚弱相比，与身体功能受损、衰弱和虚弱相关。需要研究确定减少患者药物治疗方案的策略。
