癌症幸存者的多种药物治疗和处方药物使用模式。
Polypharmacy and patterns of prescription medication use among cancer survivors.
机构信息
Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
Cancer. 2018 Jul 1;124(13):2850-2857. doi: 10.1002/cncr.31389. Epub 2018 Apr 12.
BACKGROUND
The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors.
METHODS
Using data from the Medical Expenditure Panel Survey (MEPS), the authors matched cancer survivors (5216 survivors) with noncancer controls (19,588 controls) by age, sex, and survey year. Polypharmacy was defined as ≥5 unique medications. The authors estimated the percentage of respondents prescribed medications within therapeutic classes and total prescription expenditures.
RESULTS
A higher percentage of cancer survivors were prescribed ≥5 unique medications (64.0%; 95% confidence interval [95% CI], 62.3%-65.8%) compared with noncancer controls (51.5%; 95% CI, 50.4%-52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher percentage of newly (≤1 year since diagnosis) and previously (>1 years since diagnosis) diagnosed survivors were prescribed medications compared with controls, with large differences observed with regard to central nervous system agents (65.8% [95% CI, 62.3%-69.3%] vs 57.4% [95% CI, 55.3%-59.5%] vs 46.0% [95% CI, 45.0%-46.9%]). Specifically, nearly 10% of survivors were prescribed benzodiazepines and/or opioids compared with approximately 5% of controls. Survivors had more than double the prescription expenditures (median of $1633 vs $784 among controls). Findings persisted across age and comorbidity categories.
CONCLUSIONS
Cancer survivors were prescribed a higher number of unique medications, including drugs with abuse potential, thereby increasing their risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Cancer 2018;124:2850-2857. © 2018 American Cancer Society.
背景
在美国，癌症幸存者的人数正在迅速增长。癌症的长期和晚期影响，加上对其他慢性疾病的持续管理，使幸存者特别容易出现多种药物并用及其不良反应。在本研究中，作者研究了基于人群的癌症幸存者样本中处方药物使用和多种药物并用的模式。
方法
作者使用医疗支出面板调查（MEPS）的数据，通过年龄、性别和调查年份将癌症幸存者（5216 名幸存者）与非癌症对照者（19588 名对照者）相匹配。多种药物并用定义为使用≥5 种不同药物。作者估计了每个治疗类别内处方药物的使用比例和总处方支出。
结果
与非癌症对照者（51.5%；95%置信区间[95%CI]，50.4%-52.6%）相比，更高比例的癌症幸存者（64.0%；95%CI，62.3%-65.8%）被开具≥5 种不同药物的处方，包括有滥用倾向的药物。在所有治疗类别中，与对照组相比，新诊断（≤1 年）和以前诊断（>1 年）的幸存者开具药物的比例更高，其中中枢神经系统药物的差异最大（65.8%[95%CI，62.3%-69.3%]vs 57.4%[95%CI，55.3%-59.5%]vs 46.0%[95%CI，45.0%-46.9%]）。具体来说，近 10%的幸存者被开具苯二氮䓬类药物和/或阿片类药物处方，而对照组约为 5%。幸存者的处方支出是对照组的两倍多（中位数分别为幸存者 1633 美元和对照组 784 美元）。这些发现在不同年龄和合并症类别中均存在。
结论
癌症幸存者开具了更多种类的药物，包括有滥用倾向的药物，从而增加了他们发生药物不良反应、经济毒性、药物依从性差和药物相互作用的风险。癌症 2018；124：2850-2857。©2018 美国癌症协会。
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