年龄、合并症和多药治疗对晚期癌症患者接受系统治疗的影响：一项回顾性基于人群的研究。

Impact of age, comorbidity, and polypharmacy on receipt of systemic therapy in advanced cancers: A retrospective population-based study.

机构信息

Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Medical Oncology, BC Cancer, Vancouver, Canada.

CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada.

出版信息

J Geriatr Oncol. 2024 Mar;15(2):101689. doi: 10.1016/j.jgo.2023.101689. Epub 2024 Jan 13.

DOI:10.1016/j.jgo.2023.101689

PMID:38219331

Abstract

INTRODUCTION

Cancer incidence, comorbidity, and polypharmacy increase with age, but the interplay between these factors on receipt of systemic therapy (ST) in advanced cancer has rarely been studied.

MATERIALS AND METHODS

A retrospective cohort study was conducted including patients aged ≥18 years diagnosed from 2004 to 2015 with multiple myeloma (MM) (all stages), lung cancer (stage IV), and stage III-IV non-Hodgkin's lymphoma (NHL), breast, colorectal (CRC), prostate, or ovarian cancer in Manitoba, Canada. Clinical and administrative health data were used to determine demographic and cancer characteristics, treatment history, comorbidity (Charlson Comorbidity Index [CCI] and Resource Utilization Band [RUB]), and polypharmacy (≥6 medications). Multivariable logistic regression was used to evaluate variable associations with receipt of ST and interaction with age.

RESULTS

In total, 17,228 patients were diagnosed with advanced cancer. Ages were distributed as follows: 7% <50 years, 16% 50-59 years, 26% 60-69, 26% 70-79, 24% ≥80 years. ST was administered to 50% of patients. Increased age, polypharmacy, and comorbidity each independently decreased the likelihood of receiving ST. Significant interaction effects were found between age at diagnosis with stage of cancer and cancer type. Differences in probability of ST by cancer stage converged as age increased. In multivariable analysis, adjusting for covariates, patients with MM had the highest odds and lung cancer the lowest odds to receive ST. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age.

DISCUSSION

Increased age, polypharmacy, and comorbidity were each independently associated with decreased receipt of ST in people with advanced cancers. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age, while age meaningfully interacted with stage and cancer type.

摘要

简介

癌症发病率、合并症和多药治疗随着年龄的增长而增加，但在晚期癌症中，这些因素对接受系统治疗（ST）的相互作用很少被研究。

材料和方法

进行了一项回顾性队列研究，纳入了 2004 年至 2015 年在加拿大马尼托巴省诊断为多发性骨髓瘤（MM）（所有阶段）、肺癌（IV 期）和 III-IV 期非霍奇金淋巴瘤（NHL）、乳腺癌、结直肠癌（CRC）、前列腺癌或卵巢癌的年龄≥18 岁的患者。临床和行政健康数据用于确定人口统计学和癌症特征、治疗史、合并症（Charlson 合并症指数[CCI]和资源利用带[RUB]）和多药治疗（≥6 种药物）。多变量逻辑回归用于评估与接受 ST 相关的变量及其与年龄的相互作用。

结果

共有 17228 名患者被诊断为晚期癌症。年龄分布如下：<50 岁占 7%，50-59 岁占 16%，60-69 岁占 26%，70-79 岁占 26%，≥80 岁占 24%。50%的患者接受了 ST。年龄增长、多药治疗和合并症均独立降低了接受 ST 的可能性。在诊断时的年龄与癌症的分期和癌症类型之间发现了显著的交互作用。随着年龄的增长，ST 的概率差异逐渐收敛。在多变量分析中，调整协变量后，MM 患者接受 ST 的可能性最高，肺癌患者接受 ST 的可能性最低。随着年龄的增长，合并症和多药治疗的影响没有明显差异。