Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Nitte (Deemed to be University), Mangalore, India.
Department of Radiation Therapy and Oncology, K S Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India.
J Oncol Pharm Pract. 2023 Dec;29(8):2007-2013. doi: 10.1177/10781552231207839. Epub 2023 Oct 17.
To provide an integrated approach for deprescribing practice in oncology setting.
The data on deprescribing in oncology settings has been retrieved from the PubMed, Scopus and Google Scholar. We used "deprescribing," "potentially inappropriate medication" and "cancer" as a keyword for the conducting general search. The articles relevant to guidelines or tools used to deprescribe in cancer care were included.
The nature of cancer, its treatment strategies, adverse effects of therapy and multimorbidity impact negatively on quality of life (QoL). Further, they invite polypharmacy which puts the patient at higher risk of drug-related problems like drug interactions, adverse drug reactions and addition of potentially improper medications, etc. In older adults with cancer, the incidence of potentially inappropriate medications (PIMs) was between 41% and 52%. Over the decades, multiple strategies have been developed to assess the appropriateness of therapy. One such approach is deprescribing. OncPal and oncoSTRIP (Systematic Tool to Reduce Inappropriate Prescribing) are the cancer specific guidelines whereas BEERs criteria, Screening Tool to Alert to Right Treatment/Screening Tool of Older Person's Prescriptions criteria (START/STOPP criteria), medication appropriateness index (MAI) are the cancer nonspecific tools to identify PIM among cancer patients. Here, we provided an integrative approach and algorithm for deprescribing in oncology setting which includes patient and caregiver goals, life expectancy (LE), review of medications, determining medication appropriateness, assessment of time to benefit (TTB), symptomatic and asymptomatic care, identifying medications to cease, implementation of the plan, monitoring and reviewing.
Deprescribing in oncology setting is a novel and effective patient-centric approach to counteract the use of PIM, which helps to mitigate polypharmacy, drug-drug interactions, and adverse effects.
提供一种综合方法用于肿瘤治疗环境下的减药实践。
我们从 PubMed、Scopus 和 Google Scholar 检索了肿瘤治疗环境下的减药相关数据。我们使用“减药”“潜在不适当药物”和“癌症”作为关键词进行了一般搜索。纳入了与癌症护理中使用的指南或工具相关的文章。
癌症的性质、治疗策略、治疗的不良反应以及合并症对生活质量（QoL）有负面影响。此外，它们导致了多种药物的使用，使患者面临更高的药物相关问题风险，如药物相互作用、药物不良反应以及潜在不适当药物的添加等。在患有癌症的老年患者中，潜在不适当药物（PIMs）的发生率在 41%至 52%之间。几十年来，已经开发出多种策略来评估治疗的适当性。其中一种方法是减药。OncPal 和 oncoSTRIP（用于减少不适当处方的系统工具）是专门针对癌症的指南，而 BEERs 标准、适合治疗的警报筛选工具/老年人处方筛选工具（START/STOPP 标准）、药物适宜性指数（MAI）是用于识别癌症患者中 PIM 的非癌症特异性工具。在这里，我们提供了一种综合方法和算法用于肿瘤治疗环境下的减药，其中包括患者和护理人员的目标、预期寿命（LE）、药物审查、确定药物适宜性、获益时间评估（TTB）、症状和无症状护理、确定需要停止的药物、计划的实施、监测和审查。
肿瘤治疗环境下的减药是一种新颖且有效的以患者为中心的方法，可用于对抗潜在不适当药物的使用，有助于减少多种药物的使用、药物-药物相互作用和不良反应。
