Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Network Aging Research, University of Heidelberg, Germany.
J Gerontol A Biol Sci Med Sci. 2021 May 22;76(6):1044-1052. doi: 10.1093/gerona/glaa128.
Both polypharmacy and potentially inappropriate medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and postoperative complications have been meta-analyzed previously.
A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least one out of five predefined adverse health outcomes in a population of older cancer patients (≥60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model.
Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25-1.50]), hospitalization (1.53 [1.37-1.71]), treatment-related toxicity (1.22 [1.01-1.47]), and postoperative complications (1.73 [1.36-2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p < .05 significance level (1.62 [0.98-2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08-1.88]) was observed but not with other adverse outcomes.
Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.
在老年癌症患者中，同时使用多种药物和潜在不适当药物（PIM）的情况非常普遍。然而，之前只有关于多种药物使用与术后并发症之间关联的研究进行了荟萃分析。
系统检索了 1991 年 1 月至 2020 年 3 月期间发表的关于在老年癌症患者（≥60 岁）人群中，多种药物使用或 PIM 与至少五个预先定义的不良健康结果之一之间关联的前瞻性/回顾性观察研究的文献，并进行了系统评价和荟萃分析。使用 PubMed 和 Web of Science 搜索相关研究。采用随机效应模型对数据进行合并。
共有 42 篇文献纳入系统评价。对 39 项关于多种药物使用的研究和 13 项关于 PIM 的研究进行了荟萃分析。结果显示，多种药物使用与全因死亡率（风险比[95%置信区间]：1.37[1.25-1.50]）、住院治疗（1.53[1.37-1.71]）、治疗相关毒性（1.22[1.01-1.47]）和术后并发症（1.73[1.36-2.20]）均存在统计学显著关联。但在 p<0.05 显著性水平上，多种药物使用与住院时间延长之间的关联没有统计学意义（1.62[0.98-2.66]）。关于 PIM，观察到与全因死亡率（1.43[1.08-1.88]）存在统计学显著关联，但与其他不良结局无关。
在老年癌症患者中，多种药物使用与多种不良结局有关，而 PIM 使用与全因死亡率有关。然而，由于所确定的研究中有四分之三左右没有调整共病情况，且容易受到指示性偏倚的影响，因此这些结果应谨慎解释。
