James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
Department of Pharmacy Practice, Wegmans School of Pharmacy, Rochester, NY, USA.
Oncologist. 2022 Jul 5;27(7):e580-e588. doi: 10.1093/oncolo/oyac053.
Polypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI.
This secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons' Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI.
Among 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains.
In a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.
在开始癌症治疗的老年患者中，多药治疗很常见，且与潜在不合理药物（PIM）、潜在药物-药物相互作用（DDI）和药物-癌症治疗相互作用（DCI）有关。对于开始治疗的大量患有晚期癌症的脆弱老年患者，我们描述了处方和非处方药物使用模式、PIM 的流行程度以及 DDI/DCI 的流行程度、严重程度和类型。
这项二次分析使用了一项随机研究的基线数据，该研究纳入了年龄≥70 岁、开始新的全身癌症治疗的晚期癌症患者（罗彻斯特大学癌症中心 [URCC] 13059；PI：Mohile）。使用 2019 年 Beers 标准和老年人用药筛选工具对 PIM 进行分类。使用 Lexi-Interact Online 评估潜在的 DDI/DCI。药物分类遵循世界卫生组织解剖治疗化学系统。使用二元关联评估社会人口统计学和老年评估（GA）指标与药物指标之间的关系。使用和弦图和网络分析来理解和描述 DDI/DCI。
在 718 名患者（平均年龄 77.6 岁）中，分别有 61.3%、14.5%和 67.1%的患者存在多药治疗（≥5 种药物）、过度多药治疗（≥10 种药物）和≥1 种 PIM。心血管药物最为常见（占 47%），非处方药物占总药物的 26%和 PIM 的 40%。四分之一的患者有≥1 种未涉及癌症治疗的潜在主要 DDI，5.4%的患者有≥1 种潜在主要 DCI。每增加一种药物，发生潜在主要 DDI 和 DCI 的几率分别增加 39%和 12%。多药治疗和 PIM 与多个 GA 领域有关。
在开始治疗的患有晚期癌症的脆弱老年患者队列中，多药治疗、PIM 和潜在的 DDI/DCI 非常常见。非处方药物通常是 PIM 并且/或者与潜在的 DDI/DCI 有关。
