Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States of America.
J Geriatr Oncol. 2022 Jun;13(5):624-628. doi: 10.1016/j.jgo.2021.12.010. Epub 2022 Jan 5.
Polypharmacy is a common problem among older adults that can complicate cancer care and outcomes. Our objective was to examine the prevalence of polypharmacy and its potential association with functional status impairments, frailty, and health-related quality of life (HRQoL) in older adults with gastrointestinal (GI) malignancy.
The Cancer and Aging Resilience Evaluation (CARE) registry is an ongoing prospective cohort study that uses a patient-reported geriatric assessment (GA) in older adults with cancer. For this cross-sectional analysis, we focused on older adults with GI malignancy that completed the GA prior to starting systemic cancer therapy. Polypharmacy was defined as patients reporting the use of ≥9 daily medications at their first visit to the medical oncology clinic. Using multivariable analyses, we examined the association of polypharmacy with functional status limitations, frailty, and HRQoL.
357 patients were included in our analysis, with a mean age of 70.1 years. 24.1% of patients reported taking ≥9 medications. In multivariable analyses adjusted for age, sex, race, cancer type, cancer stage, and medical comorbid conditions, patients taking ≥9 medications were more likely to report limitations in activities of daily living (adjusted odds ratio [aOR] 3.29, 95% confidence interval [CI] 1.72-6.29) and instrumental activities of daily living (aOR 2.86, 95% CI 1.59-5.14), have a higher prevalence of frailty (aOR 3.06, 95% CI 1.73-5.41), and report lower physical HRQoL (aOR 2.82, 95% CI 1.70-4.69) and mental HRQoL (aOR 1.73, 95% CI 1.03-2.91).
Older adults with GI malignancy taking ≥9 medications prior to cancer therapy were more likely to report functional status limitations, frailty, and reduced HRQoL, independent of the presence of medical comorbid conditions.
老年人普遍存在多种药物治疗的问题，这可能会使癌症的治疗和预后复杂化。我们的目的是研究胃肠道（GI）恶性肿瘤老年患者中多种药物治疗的流行情况及其与功能状态受损、虚弱和健康相关生活质量（HRQoL）的潜在关联。
癌症与衰老韧性评估（CARE）登记是一项正在进行的前瞻性队列研究，该研究在癌症老年患者中使用患者报告的老年综合评估（GA）。在这项横断面分析中，我们专注于在开始全身癌症治疗前完成 GA 的胃肠道恶性肿瘤老年患者。多种药物治疗定义为患者在首次就诊于肿瘤内科诊所时报告使用≥9 种日常药物。我们使用多变量分析检查了多种药物治疗与功能状态受限、虚弱和 HRQoL 的关联。
我们的分析纳入了 357 例患者，平均年龄为 70.1 岁。24.1%的患者报告服用≥9 种药物。在调整年龄、性别、种族、癌症类型、癌症分期和合并症后，多变量分析显示，服用≥9 种药物的患者更有可能报告日常生活活动受限（调整后的优势比[aOR]3.29，95%置信区间[CI]1.72-6.29）和工具性日常生活活动受限（aOR 2.86，95%CI 1.59-5.14），虚弱的患病率更高（aOR 3.06，95%CI 1.73-5.41），以及报告较低的身体 HRQoL（aOR 2.82，95%CI 1.70-4.69）和精神 HRQoL（aOR 1.73，95%CI 1.03-2.91）。
在开始癌症治疗前服用≥9 种药物的胃肠道恶性肿瘤老年患者更有可能报告功能状态受限、虚弱和降低的 HRQoL，而与是否存在合并症无关。
