老年乳腺癌和结直肠癌患者潜在不适当药物使用。
Potentially inappropriate medication use in older patients with breast and colorectal cancer.
机构信息
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
出版信息
Cancer. 2018 Jul 15;124(14):3000-3007. doi: 10.1002/cncr.31403. Epub 2018 Apr 24.
BACKGROUND
The objective of this study was to determine patient characteristics associated with potentially inappropriate medication (PIM) use and its impact on outcomes for patients with breast or colorectal cancer receiving adjuvant chemotherapy.
METHODS
The Surveillance, Epidemiology, and End Results database, linked to Medicare claims, was used. The cohort included patients who were 66 years old or older and were diagnosed with stage II or III breast or colorectal cancer between July 1, 2007, and December 31, 2009. The Drugs to Avoid in the Elderly (DAE) list and the Beers criteria were used to identify PIM use. Univariate/multivariate logistic regression determined the association of baseline PIMs with covariates. Event-free survival (EFS) was defined as the time from chemotherapy initiation to the first emergency room (ER) visit, hospitalization, death, or a composite until 3 months after chemotherapy. Cox proportional hazards modeling determined the association of PIMs with EFS.
RESULTS
The analysis included 1595 patients with breast cancer and 1528 patients with colorectal cancer. The baseline PIM frequencies were 22.2% (according to the DAE list) and 27.6% (according to the Beers criteria) in the breast cohort and 15.5% (according to the DAE list) and 24.8% (according to the Beers criteria) in the colorectal cohort. Among patients with breast cancer, 37.5% had at least 1 adverse outcome; associations included the use of ≥5 medications, an advanced stage, higher comorbidity, and prior ER visits/hospitalizations. Baseline PIM use according to the DAE list was associated with an increased risk of death in patients with breast cancer. Among patients with colorectal cancer, 45% had at least 1 adverse outcome, and associations included the use of ≥5 medications, older age, female sex, and higher comorbidity. A time-to-event analysis revealed no association between baseline PIM use and most outcomes.
CONCLUSIONS
These findings require further prospective confirmation, but they support a correlation between polypharmacy and adverse outcomes for cancer patients and call into question the association with PIMs. Cancer 2018;124:3000-7. © 2018 American Cancer Society.
背景
本研究旨在确定与接受辅助化疗的乳腺癌或结直肠癌患者潜在不适当药物（PIM）使用相关的患者特征及其对结局的影响。
方法
使用监测、流行病学和最终结果（SEER）数据库，与医疗保险索赔相关联。该队列包括年龄在 66 岁或以上，于 2007 年 7 月 1 日至 2009 年 12 月 31 日期间被诊断为 II 期或 III 期乳腺癌或结直肠癌的患者。使用药物避免在老年人（DAE）清单和 Beers 标准来确定 PIM 使用。单变量/多变量逻辑回归确定了基线 PIMs 与协变量的关联。无事件生存（EFS）定义为从化疗开始到第一次急诊就诊、住院、死亡或直至化疗后 3 个月的复合终点的时间。Cox 比例风险模型确定了 PIMs 与 EFS 的关联。
结果
分析包括 1595 例乳腺癌患者和 1528 例结直肠癌患者。乳腺癌队列的基线 PIM 频率为 22.2%（根据 DAE 清单）和 27.6%（根据 Beers 标准），结直肠癌队列为 15.5%（根据 DAE 清单）和 24.8%（根据 Beers 标准）。在乳腺癌患者中，有 37.5%至少有 1 个不良结局；关联包括使用≥5 种药物、晚期、更高的合并症和之前的急诊就诊/住院。根据 DAE 清单，基线 PIM 使用与乳腺癌患者的死亡风险增加相关。在结直肠癌患者中，有 45%至少有 1 个不良结局，关联包括使用≥5 种药物、年龄较大、女性和更高的合并症。时间事件分析显示，基线 PIM 使用与大多数结局之间没有关联。
结论
这些发现需要进一步的前瞻性证实，但它们支持癌症患者药物使用与不良结局之间的相关性，并对 PIMs 的相关性提出质疑。癌症 2018；124：3000-7。©2018 美国癌症协会。
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