School of Medicine, University College Cork, Cork, Ireland
Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.
Oncologist. 2019 Sep;24(9):e968-e977. doi: 10.1634/theoncologist.2018-0476. Epub 2019 Mar 4.
Our goal was to determine (a) the prevalence of multimorbidity and polypharmacy in patients with cancer and (b) the prevalence, predictability, and preventability of adverse drug reactions (ADRs) causing/contributing to hospitalization.
We conducted a 12-month prospective observational study of patients aged ≥16 years admitted to an oncology center. Older adults were aged ≥70 years.
We enrolled 350 patients: 52.3% ( = 183) female, mean age 63.6 years (SD 12.1), 36.6% ( = 121) aged ≥70 years. Multimorbidity (≥2 conditions) was identified in 96.9%; 68% had ≥5 conditions. The median number of medications was 6 (interquartile range [IQR] 4-8); 47% were prescribed ≥6 medications and 11.4% ≥11 medications. Older adults had higher numbers of comorbid conditions (7 [IQR 5-10] vs. 5 [IQR 3-7]) and were prescribed more medications (median 7 [IQR 4-9] vs. 4 [IQR 2-7]). ADRs caused/contributed to hospitalization in 21.5% ( = 75): 35.8% ( = 72) of emergency admissions and 4.7% ( = 3) of elective admissions. The most common ADRs were neutropenia with infection (25.3%), dyspepsia/nausea/vomiting (20%), and constipation (20%). Causative medications included systemic anticancer therapies (SACTs; 53.3%), opioids (17.3%), corticosteroids (6.7%), and nonsteroidal anti-inflammatory drugs (5.3%). ADR prevalence was similar in older and younger adults secondary to SACTs (8.3% vs. 13.1%), non-cancer medications (10.7% vs. 8.3%), and both (0% vs. 1.3%). ADRs were predictable in 89.3% ( = 67), definitely avoidable in 29.3% ( = 22), and possibly avoidable in 33.3% ( = 25). No association was identified between ADRs and age, gender, daily medication number, length of stay, or death. No ADR predictor variables were identified by logistic regression.
More than 21% of admissions to an oncology service are ADR-related. ADRs are caused by both SACTs and non-cancer-specific medications. The majority are predictable; ≥60% may be preventable. Patients with cancer have high levels of multimorbidity and polypharmacy, which require vigilance for related adverse outcomes.
A diagnosis of cancer often occurs in patients with multimorbidity and polypharmacy. Cancer can cause an altered physiological environment, placing patients at risk of drug-drug interactions, drug-disease interactions, and adverse drug reactions (ADRs). This study identified that ADRs caused or contributed to one in five hospital admissions of patients with cancer. ADRs were caused by systemic anticancer therapies (SACTs) in 53.3% of cases and non-cancer medications in 45.4% of cases, and a combination of both in 1.3%. ADRs occurred in similar frequencies in older and younger patients secondary to SACTs (8.3% vs. 13.1%, = .295), non-SACTs (10.7% vs. 8.3%, = .107), and a combination of both (0% vs. 1.3%, = .240). The majority of ADRs were predictable (89.3%) and potentially preventable (62.6%). These findings support the need for increased awareness of medication-related adversity in patients with cancer and interventions to minimize their occurrence, thus supporting the American Society of Clinical Oncology guidelines that recommend adults ≥65 years of age receiving chemotherapy have geriatric assessment to identify medical and medication issues.
我们的目标是确定(a)癌症患者的合并症和多重用药的流行率，以及(b)药物不良反应（ADR）导致/促成住院的发生率、可预测性和可预防性。
我们进行了一项为期 12 个月的前瞻性观察性研究，纳入了年龄≥16 岁、入住肿瘤中心的患者。老年人的年龄≥70 岁。
我们共纳入 350 名患者：52.3%（=183）为女性，平均年龄 63.6 岁（标准差 12.1），36.6%（=121）年龄≥70 岁。96.9%的患者存在合并症（≥2 种疾病）；68%的患者存在≥5 种合并症。中位数的用药数量为 6 种（四分位距 [IQR] 4-8）；47%的患者处方≥6 种药物，11.4%的患者处方≥11 种药物。老年患者的合并症数量更多（7 [IQR 5-10] 与 5 [IQR 3-7]），处方药物更多（中位数 7 [IQR 4-9] 与 4 [IQR 2-7]）。21.5%（=75）的药物不良反应导致/促成了住院：35.8%（=72）为急诊入院，4.7%（=3）为择期入院。最常见的药物不良反应是中性粒细胞减少伴感染（25.3%）、消化不良/恶心/呕吐（20%）和便秘（20%）。导致药物不良反应的药物包括全身性抗癌治疗（SACTs；53.3%）、阿片类药物（17.3%）、皮质类固醇（6.7%）和非甾体抗炎药（5.3%）。由于 SACTs（8.3% 与 13.1%，=0.295）、非癌症药物（10.7% 与 8.3%，=0.107）和两者（0% 与 1.3%，=0.240），老年和年轻患者的药物不良反应发生率相似。89.3%（=67）的药物不良反应可预测，29.3%（=22）的药物不良反应肯定可避免，33.3%（=25）的药物不良反应可能可避免。药物不良反应与年龄、性别、每日用药数量、住院时间或死亡无关。逻辑回归未确定药物不良反应的预测变量。
肿瘤科服务的入院中有超过 21%与药物不良反应相关。药物不良反应由 SACTs 和非癌症特异性药物引起。大多数药物不良反应是可预测的；≥60%的药物不良反应可能是可预防的。患有癌症的患者合并症和多重用药水平较高，需要密切关注相关不良结局。
癌症的诊断通常发生在合并症和多重用药的患者中。癌症会引起生理环境的改变，使患者面临药物-药物相互作用、药物-疾病相互作用和药物不良反应（ADR）的风险。本研究确定，药物不良反应导致或促成了 20%的癌症患者住院。ADR 是由全身性抗癌治疗（SACTs）引起的，占 53.3%，由非癌症药物引起的占 45.4%，两者结合引起的占 1.3%。由于 SACTs（8.3% 与 13.1%，=0.295）、非 SACTs（10.7% 与 8.3%，=0.107）和两者（0% 与 1.3%，=0.240），SACTs 和非 SACTs 导致的药物不良反应在老年和年轻患者中的发生率相似。大多数药物不良反应是可预测的（89.3%），潜在可预防的（62.6%）。这些发现支持了在癌症患者中增加对药物相关不良反应的认识，并采取干预措施以尽量减少其发生的必要性，从而支持了美国临床肿瘤学会的指南，该指南建议≥65 岁接受化疗的成年人进行老年评估，以确定医疗和药物问题。
