Whitman Andrew, Erdeljac Paige, Jones Caroline, Pillarella Nicole, Nightingale Ginah
Department of Pharmacy, University of Virginia Health, Charlottesville, VA, USA.
Department of Pharmacy, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Drug Healthc Patient Saf. 2021 Apr 29;13:101-116. doi: 10.2147/DHPS.S255893. eCollection 2021.
The care of older patients with cancer is becoming increasingly complex. Common challenges for this population include management of comorbidities, safe transitions of care, and appropriate medication use. In particular, polypharmacy-generally defined as the regular use of five or more medications-and inappropriate medication use can lead to adverse effects and poor outcomes in older adults with cancer, including falls, hospital readmissions, cognitive impairment, poor adherence to essential medications, chemotherapy toxicity, and increased mortality. Managing polypharmacy across different cancer care settings is often challenging. Providers face barriers to safe and successful medication management that may include lack of time, absence of reimbursement, underappreciation of the scale of polypharmacy-related harm, lack of ownership of deprescribing efforts, and poor communication across care settings. Existing literature on managing inappropriate medication use and polypharmacy in older adults with cancer has often focused on ideal state settings in which resources are plentiful and time is purposefully allocated for medication interventions. This paper presents a narrative, rather than a systematic review, of studies published in the past decade that provided detailed information on medication management and polypharmacy across cancer care settings. This review aims to also summarize different healthcare provider roles in taking action against inappropriate medication use and polypharmacy in older adults with cancer.
老年癌症患者的护理正变得日益复杂。这一人群面临的常见挑战包括合并症的管理、安全的护理过渡以及药物的合理使用。特别是，多重用药（一般定义为常规使用五种或更多药物）和不当用药会导致老年癌症患者出现不良反应和不良后果，包括跌倒、再次入院、认知障碍、对基本药物的依从性差、化疗毒性以及死亡率增加。在不同的癌症护理环境中管理多重用药往往具有挑战性。医疗服务提供者在安全、成功地进行药物管理方面面临障碍，这些障碍可能包括时间不足、缺乏报销、对多重用药相关危害的规模认识不足、缺乏减药工作的主导权以及不同护理环境之间沟通不畅。现有关于管理老年癌症患者不当用药和多重用药的文献通常聚焦于理想状态的环境，即资源丰富且有专门时间用于药物干预。本文对过去十年发表的研究进行了叙述性而非系统性的综述，这些研究提供了有关不同癌症护理环境中药物管理和多重用药的详细信息。本综述还旨在总结不同医疗服务提供者在应对老年癌症患者不当用药和多重用药方面所扮演的角色。
