Ewig Celeste L Y, Cheng Yi Man, Li Hoi Shan, Wong Jasper Chak Ling, Cho Alex Hong Yu, Poon Freddie Man Hong, Li Chi Kong, Cheung Yin Ting
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Department of Pharmacy, Hong Kong Children's Hospital, Hong Kong, China.
Front Oncol. 2021 Apr 1;11:642544. doi: 10.3389/fonc.2021.642544. eCollection 2021.
As survivors of childhood cancer age, development of cancer treatment-related chronic health conditions often occur. This study aimed to describe the pattern of chronic prescription medication use and identify factors associated with polypharmacy among survivors of childhood cancer.
This was a retrospective study conducted at the pediatric oncology long-term follow-up clinic in Hong Kong. Eligible subjects included survivors who were (1) diagnosed with cancer before 18 years old, (2) were at least 3 years post-cancer diagnosis and had completed treatment for at least 30 days, and (3) receiving long-term follow-up care at the study site between 2015 and 2018. Dispensing records of eligible survivors were reviewed to identify medications taken daily for ≥30 days or used on an "as needed" basis for ≥6 months cumulatively within the past 12-month period. Polypharmacy was defined as the concurrent use of ≥5 chronic medications. Multivariable log-binomial modeling was conducted to identify treatment and clinical factors associated with medication use pattern and polypharmacy.
This study included 625 survivors (mean current age = 17.9 years, standard deviation [SD] = 7.2 years) who were 9.2 [5.2] years post-treatment. Approximately one-third (n = 219, 35.0%) of survivors were prescribed at least one chronic medication. Frequently prescribed medication classes include systemic antihistamines (26.5%), sex hormones (19.2%), and thyroid replacement therapy (16.0%). Overall prevalence of polypharmacy was 5.3% (n = 33). A higher rate of polypharmacy was found in survivors of CNS tumors (13.6%) than in survivors of hematological malignancies (4.3%) and other solid tumors (5.3%) ( = .0051). Higher medication burden was also observed in survivors who had undergone cranial radiation (RR = 6.31; 95% CI = 2.75-14.49) or hematopoietic stem-cell transplantation (HSCT) (RR = 3.53; 95% CI = 1.59-7.83).
Although polypharmacy was observed in a minority of included survivors of childhood cancer, chronic medication use was common. Special attention should be paid to survivors of CNS tumors and survivors who have undergone HSCT or cranial radiation. These individuals should be monitored closely for drug-drug interactions and adverse health outcomes that may result from multiple chronic medications, particularly during hospitalization in an acute care setting.
随着儿童癌症幸存者年龄增长，与癌症治疗相关的慢性健康问题常常出现。本研究旨在描述慢性处方药的使用模式，并确定儿童癌症幸存者中与多重用药相关的因素。
这是一项在香港儿科肿瘤长期随访诊所进行的回顾性研究。符合条件的受试者包括：（1）18岁前被诊断为癌症的幸存者；（2）癌症诊断后至少3年且完成治疗至少30天；（3）2015年至2018年在研究地点接受长期随访护理。审查符合条件的幸存者的配药记录，以确定在过去12个月内每天服用≥30天或累计“按需”使用≥6个月的药物。多重用药定义为同时使用≥5种慢性药物。进行多变量对数二项式建模，以确定与用药模式和多重用药相关的治疗和临床因素。
本研究纳入了625名幸存者（当前平均年龄 = 17.9岁，标准差[SD] = 7.2岁），他们在治疗后9.2[5.2]年。约三分之一（n = 219，35.0%）的幸存者被开具了至少一种慢性药物。经常开具的药物类别包括全身性抗组胺药（26.5%）、性激素（19.2%）和甲状腺替代疗法（16.0%）。多重用药的总体患病率为5.3%（n = 33）。中枢神经系统肿瘤幸存者的多重用药率（13.6%）高于血液系统恶性肿瘤幸存者（4.3%）和其他实体瘤幸存者（5.3%）（P = 0.0051）。接受过颅脑放疗（RR = 6.31；95%CI = 2.75 - 14.49）或造血干细胞移植（HSCT）（RR = 3.53；95%CI = 1.59 - 7.83）的幸存者也观察到更高的用药负担。
虽然在纳入的少数儿童癌症幸存者中观察到了多重用药情况，但慢性药物使用很常见。应特别关注中枢神经系统肿瘤幸存者以及接受过HSCT或颅脑放疗的幸存者。应对这些个体密切监测可能由多种慢性药物导致的药物相互作用和不良健康后果，尤其是在急性护理环境中的住院期间。
