老年人癌症患者口服抗癌药物治疗的耐受性：电子健康记录数据分析的二次分析和患者报告结局的初步研究。

Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes.

机构信息

University of Michigan School of Nursing, Ann Arbor, MI, USA.

Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 North Ingalls Building, Room 4160, Ann Arbor, MI, 48109, USA.

出版信息

BMC Cancer. 2022 Sep 3;22(1):950. doi: 10.1186/s12885-022-10026-3.

DOI:10.1186/s12885-022-10026-3

PMID:36057578

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9440580/

Abstract

BACKGROUND

More than 60% of cancer cases occur in older adults, and many are treated with oral anticancer agents. Yet, the treatment tolerability in older adults has not been fully understood due to their underrepresentation in oncology clinical trials, creating challenges for treatment decision-making and symptom management. The objective of this study was to investigate the tolerance of capecitabine, an example of oral chemotherapy, among older adults with cancer and explore factors associated with capecitabine-related side effects and treatment changes, to enhance supportive care.

METHODS

A secondary analysis used combined data from electronic health records and a pilot study of patient-reported outcomes, with a total of 97 adult patients taking capecitabine during 2016-2017, including older adult patients aged 65 years or older (n = 43). The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Bivariate correlations, negative binomial regression, and multiple linear regression were conducted for data analysis.

RESULTS

Older adults were more likely to experience fatigue (86% vs. 51%, p = .001) and experienced more severe fatigue (β = 0.44, p = 0.03) and hand-foot syndrome (HFS) (β = 1.15, p = 0.004) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications (β = 0.06, p = 0.006) and the duration of treatment (β = 0.50, p = 0.009), respectively. Correlations among side effects presented different patterns between younger and older adults. Although more older adults experienced dose reductions (21% vs. 13%) and dose interruptions (33% vs. 28%) than younger adults, the differences were not statistically different. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with dose reductions (p-values < 0.05).

CONCLUSIONS

Older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults. While dose reductions are common among older adults, age 65 years or older may not be an independent factor of treatment changes. Other socio-demographic and clinical factors may be more likely to be associated. Future studies can be conducted to further explore older adults' tolerance to a variety of oral anticancer agents to generate more evidence to support optimal treatment decision-making and symptom management.

摘要

背景

超过 60%的癌症病例发生在老年人中，许多人接受口服抗癌药物治疗。然而，由于老年人在肿瘤学临床试验中的代表性不足，他们的治疗耐受性尚未得到充分了解，这给治疗决策和症状管理带来了挑战。本研究的目的是调查卡培他滨（一种口服化疗药物）在老年癌症患者中的耐受性，并探讨与卡培他滨相关副作用和治疗改变相关的因素，以加强支持性护理。

方法

对电子健康记录和患者报告结局的试点研究进行二次分析，共有 97 名 2016-2017 年期间接受卡培他滨治疗的成年患者，包括 65 岁或以上的老年患者（n=43）。提取的数据包括患者的社会人口统计学信息、卡培他滨信息、副作用和卡培他滨治疗改变（剂量减少和剂量中断）。进行了双变量相关性、负二项回归和多元线性回归分析。

结果

与年轻患者相比，老年患者更有可能出现疲劳（86% vs. 51%，p=0.001），且疲劳更严重（β=0.44，p=0.03）和手足综合征（HFS）（β=1.15，p=0.004）。疲劳和 HFS 的严重程度与门诊用药数量（β=0.06，p=0.006）和治疗持续时间（β=0.50，p=0.009）相关。年轻患者和老年患者的副作用之间存在不同的相关性模式。尽管更多的老年患者经历了剂量减少（21% vs. 13%）和剂量中断（33% vs. 28%），但差异无统计学意义。女性、乳腺癌诊断、卡培他滨单药治疗和严重 HFS 与剂量减少相关（p 值均<0.05）。

结论

与年轻患者相比，老年患者不太可能耐受卡培他滨治疗，且与年轻患者相比，出现了不同的共同副作用。虽然老年患者中剂量减少很常见，但 65 岁或以上的年龄可能不是治疗改变的独立因素。其他社会人口统计学和临床因素可能更有可能相关。未来的研究可以进一步探讨老年患者对各种口服抗癌药物的耐受性，以产生更多的证据支持最佳的治疗决策和症状管理。