Miller School of Medicine, University of Miami, Miami, Florida, USA.
Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA.
Oncologist. 2019 Sep;24(9):1201-1208. doi: 10.1634/theoncologist.2018-0807. Epub 2019 Apr 5.
Polypharmacy has been associated with morbidity and mortality in patients with cancer. Data about polypharmacy among patients with ovarian cancer are limited. The primary objective of this study was to evaluate polypharmacy in a cohort of patients with ovarian cancer and to assess the evolution of polypharmacy from initial presentation to 2 years posttreatment. A secondary objective was to evaluate differences in polypharmacy between a subset of patients primarily treated in our comprehensive cancer center (CCC) and our safety net hospital (SNH).
Women treated for ovarian cancer between January 1, 2011, and December 31, 2016, were included. Data were abstracted from the electronic medical record. Medication safety was assessed using the established Anticholinergic Burden (ACB) scale and the Beers criteria. Statistical analyses were performed using paired tests and Cox proportional hazards models, with significance set at < .05.
The study included 152 patients. The majority of patients had high-grade serous carcinoma. Hypertension was the most common medical problem. The mean number of medications at the time of diagnosis was 3.72. Paired testing demonstrated significant patient-level increases in the number medications at 2 years following initial diagnosis (4.16 vs. 7.01, < .001). At the CCC, 47.4% of patients met criteria for polypharmacy at diagnosis compared with 19.4% at the SNH ( < .001). By 2 years postdiagnosis, 77.6% of patients at the CCC met criteria for polypharmacy compared with 43.3% at the SNH ( = .001). The use of any medications on the ACB scale ( < .001) increased significantly between initial diagnosis and 2 years for the entire population. Polypharmacy was not a significant predictor of overall survival.
Polypharmacy worsens as women go through ovarian cancer treatment. Both at initial presentation and at 2 years postdiagnosis, rates of polypharmacy were higher at the CCC. Polypharmacy did not have an effect on survival in this cohort.
Awareness of escalating numbers of medications and potentially adverse interactions is crucial among women with ovarian cancer, who are at high risk for polypharmacy.
药物的多重使用与癌症患者的发病率和死亡率有关。有关卵巢癌患者药物多重使用的数据有限。本研究的主要目的是评估卵巢癌患者的药物多重使用情况，并评估从初始治疗到 2 年的药物多重使用的演变。次要目的是评估在我们综合癌症中心 (CCC) 和我们的安全网医院 (SNH) 主要治疗的患者亚组之间药物多重使用的差异。
纳入 2011 年 1 月 1 日至 2016 年 12 月 31 日期间接受卵巢癌治疗的女性。从电子病历中提取数据。使用既定的抗胆碱能负担 (ACB) 量表和 Beers 标准评估药物安全性。使用配对 t 检验和 Cox 比例风险模型进行统计分析，显著性水平设为 <.05。
该研究纳入了 152 名患者。大多数患者患有高级别浆液性癌。高血压是最常见的医疗问题。诊断时的平均用药数为 3.72。配对测试表明，患者在初始诊断后 2 年内的用药数量显著增加(4.16 与 7.01， <.001)。在 CCC，47.4%的患者在诊断时符合药物多重使用的标准，而在 SNH 为 19.4%（ <.001）。在诊断后 2 年，在 CCC，77.6%的患者符合药物多重使用的标准，而在 SNH 为 43.3%（ =.001）。整个人群中，使用 ACB 量表上的任何药物（ <.001）在初始诊断和 2 年内均显著增加。药物多重使用不是总生存期的显著预测因素。
随着女性接受卵巢癌治疗，药物多重使用的情况恶化。在 CCC，无论是在初始就诊时还是在诊断后 2 年，药物多重使用的比例都更高。在本队列中，药物多重使用对生存没有影响。
对于患有卵巢癌的女性，药物种类和潜在不良反应的增加是至关重要的，因为她们有药物多重使用的高风险。
