School of Medicine, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.
School of Medicine, University College Cork, Cork, Ireland; Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
J Geriatr Oncol. 2021 Jul;12(6):872-880. doi: 10.1016/j.jgo.2021.02.021. Epub 2021 Feb 27.
Older adults with cancer frequently have other co-morbidities requiring prescription pharmacotherapy. The objectives of this study were to identify the prevalence of potentially inappropriate medications (PIMs), severe drug interactions (SDIs) and associated risk factors in these patients.
This twelve-month prospective observation study was conducted at an Irish Hospital. PIMs were identified in older adults (≥65 years) using STOPP and OncPal criteria; potential SDIs using Stockley's interaction checker.
We enrolled 186 patients; mean age 72.5(SD5.7) years, 46.2% female, mean co-morbidities 7.5(SD3.4), median medications 7(IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. STOPP PIMs were observed in 73.1%; median 2(IQR1-3). The most common PIM identified was any drug prescribed beyond the recommended duration (46.5%). For each additional prescription, the odds of receiving a STOPP PIM increased by 79.2% (OR 1.792, 95% CI 1.459-2.02). Potential SDIs were identified in 50.5% participants. The most common were beta-blocker/alpha-blocker (6.5%), selective-serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (5.9%) and SSRI/Aspirin (4.8%). For each additional prescription, the odds of an SDI increased by 50.8% (OR 1.508, 95% CI 1.288-1.764). Seventy-seven (41.4%) participants died within six months of enrolment. OncPal PIMs were observed in 81.8% of this cohort, median 2(IQR1-3). The most common OncPal PIM was statin therapy (38%). For each additional prescription, the odds of receiving an OncPal PIM increased by 38.2%, (OR 1.382, 95% CI 1.080-1.767).
PIMs and SDIs are common in this population. Comprehensive specialist evaluation of medications by a geriatrician may identify PIMs thereby reducing related adverse outcomes such as SDIs.
患有癌症的老年患者常伴有其他需要处方药物治疗的合并症。本研究的目的是确定这些患者中潜在不适当药物（PIMs）、严重药物相互作用（SDIs）的发生率及其相关危险因素。
这是一项在爱尔兰医院进行的为期 12 个月的前瞻性观察研究。使用 STOPP 和 OncPal 标准识别老年患者（≥65 岁）中的 PIMs；使用 Stockley 的相互作用检查器识别潜在的 SDI。
我们共纳入 186 名患者；平均年龄 72.5（SD5.7）岁，46.2%为女性，平均合并症 7.5（SD3.4）种，中位数用药 7（IQR4-9）种。分别有 60.8%和 17.7%的患者存在多种药物治疗和主要多种药物治疗（≥11 种药物）。观察到 73.1%的患者存在 STOPP PIMs；中位数为 2（IQR1-3）种。最常见的 PIM 是任何药物的使用超过了推荐的持续时间（46.5%）。每增加一种药物，接受 STOPP PIM 的几率增加 79.2%（OR 1.792，95%CI 1.459-2.02）。50.5%的患者存在潜在的 SDI。最常见的是β受体阻滞剂/α受体阻滞剂（6.5%）、选择性 5-羟色胺再摄取抑制剂（SSRI）/质子泵抑制剂（PPI）（5.9%）和 SSRI/阿司匹林（4.8%）。每增加一种药物，发生 SDI 的几率增加 50.8%（OR 1.508，95%CI 1.288-1.764）。77 名（41.4%）患者在入组后 6 个月内死亡。该队列中 81.8%的患者存在 OncPal PIMs，中位数为 2（IQR1-3）种。最常见的 OncPal PIM 是他汀类药物治疗（38%）。每增加一种药物，接受 OncPal PIM 的几率增加 38.2%（OR 1.382，95%CI 1.080-1.767）。
该人群中 PIMs 和 SDIs 很常见。老年病专家对药物进行全面评估可能会识别出 PIMs，从而减少相关的不良后果，如 SDI。
