Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA.
Division of Geriatrics, Crozer Keystone Health System, Springfield, PA, 19126, USA.
Curr Oncol Rep. 2017 Sep 23;19(11):73. doi: 10.1007/s11912-017-0632-3.
This review explores the multiple definitions, epidemiology, and impact of polypharmacy in geriatric oncology patients. Risk factors and clinical implications of polypharmacy are delineated and potential clinical approaches to reduce polypharmacy are reviewed.
Most sources currently define polypharmacy as the administration of multiple medications that are non-essential, unnecessary, duplicative, or ineffective. Possible risk factors associated with polypharmacy in geriatric cancer patients include comorbid conditions, prescribing cascades, and hospitalization. Consequences of polypharmacy in this population include adverse drug events, drug-drug interactions, reduced adherence, frailty, and increased morbidity. Clinical approaches to the reduction of polypharmacy include thorough medication histories and an interprofessional team approach to care. Polypharmacy is common and has a direct clinical impact on geriatric oncology patients. There is a clear deficit in our understanding of the scope and impact of polypharmacy in this population and only limited evaluation of various interventions exist. The paucity of information is at least partially linked to the consistent exclusion of older adults in cancer studies and the complex interaction between polypharmacy and potential morbidities/mortality.
本综述探讨了老年肿瘤患者中多种药物治疗的多重定义、流行病学和影响。阐述了多种药物治疗的危险因素和临床意义,并回顾了潜在的减少多种药物治疗的临床方法。
目前大多数来源将多种药物治疗定义为使用非必需、不必要、重复或无效的多种药物。与老年癌症患者多种药物治疗相关的可能危险因素包括合并症、处方级联和住院治疗。该人群中多种药物治疗的后果包括药物不良事件、药物相互作用、药物依从性降低、虚弱和发病率增加。减少多种药物治疗的临床方法包括详细的药物史和跨专业团队的护理方法。多种药物治疗在老年肿瘤患者中很常见,对其有直接的临床影响。我们对该人群中多种药物治疗的范围和影响的了解明显不足,并且仅对各种干预措施进行了有限的评估。信息的缺乏至少部分归因于癌症研究中老年人的一贯排除以及多种药物治疗与潜在的发病率/死亡率之间的复杂相互作用。