优化老年多病癌症患者的药物治疗。
Optimising pharmacotherapy in older cancer patients with polypharmacy.
机构信息
Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
出版信息
Eur J Cancer Care (Engl). 2020 Jan;29(1):e13185. doi: 10.1111/ecc.13185. Epub 2019 Nov 6.
OBJECTIVE
Polypharmacy is frequent among older cancer patients and increases the risk of potential drug-related problems (DRPs). DRPs are associated with adverse drug events, drug-drug interactions and hospitalisations. Since no standardised polypharmacy assessment methods for oncology patients exist, we aimed to develop one that can be integrated into routine care.
METHODS
Based on the Systematic Tool to Reduce Inappropriate Prescribing (STRIP), we developed OncoSTRIP, which includes a polypharmacy anamnesis, a concise geriatric assessment, a polypharmacy analysis taking life expectancy into account and an optimised treatment plan. Patients ≥65 years with ≥5 chronic drugs visiting our outpatient oncology clinic were eligible for the polypharmacy assessment.
RESULTS
OncoSTRIP was integrated into routine care of our older cancer patients. In 47 of 60 patients (78%), potential DRPs (n = 101) were found. In total, 85 optimisations were recommended, with an acceptance rate of 41%. It was possible to reduce the number of potential DRPs by 41% and the number of patients with at least one potential DRP by 30%. Mean time spent per patient was 71 min.
CONCLUSIONS
Polypharmacy assessment of older cancer patients identifies many pharmacotherapeutic optimisations. With OncoSTRIP, polypharmacy assessments can be integrated into routine care.
目的
老年癌症患者常合并多种药物治疗，增加了潜在药物相关问题（DRPs）的风险。DRPs 与不良药物事件、药物相互作用和住院治疗有关。由于目前尚缺乏针对肿瘤患者的标准化药物管理评估方法，我们旨在开发一种可纳入常规治疗的方法。
方法
基于系统性减少不适当处方工具（STRIP），我们开发了 OncoSTRIP，它包括药物治疗史回顾、简明老年评估、考虑预期寿命的药物管理分析和优化治疗计划。≥65 岁且合并≥5 种慢性疾病的门诊肿瘤患者可接受药物管理评估。
结果
OncoSTRIP 已纳入我们的老年癌症患者常规治疗中。在 60 例患者中的 47 例（78%）中发现了潜在的 DRPs（n=101）。共提出 85 项优化建议，接受率为 41%。通过该方法，潜在 DRPs 的数量减少了 41%，至少存在一种潜在 DRP 的患者数量减少了 30%。每位患者的平均评估时间为 71 分钟。
结论
老年癌症患者的药物管理评估可识别许多药物治疗优化措施。通过 OncoSTRIP，药物管理评估可纳入常规治疗。
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