接受系统治疗的晚期癌症老年患者中，药物种类过多和潜在不适当药物与身体功能下降的关系。

Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment.

机构信息

Department of Public Health, University of Rochester, Rochester, NY, USA.

Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.

出版信息

Support Care Cancer. 2024 Sep 19;32(10):674. doi: 10.1007/s00520-024-08877-6.

DOI:10.1007/s00520-024-08877-6

PMID:39294452

Abstract

BACKGROUND

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment.

METHODS

This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3 months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3 months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3 months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3 months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities).

RESULTS

Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51).

CONCLUSIONS

In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.

摘要

背景

在患有晚期癌症的老年人中，同时使用多种药物和潜在不适当药物（PIM）很常见，但它们与身体功能结果的关系研究较少。本研究旨在评估在开始新的系统治疗线的老年晚期癌症患者中，药物治疗与身体功能下降风险的关系。

方法

这项 GAP 70+ 试验（PI：Mohile）的二次分析纳入了年龄在 70 岁以上、患有晚期癌症、至少有一个老年评估领域受损且计划开始使用高毒性新抗肿瘤方案的患者。在开始治疗前评估同时使用多种药物（使用≥8 种药物（药物））。使用筛选老年人处方（STOPP）标准和 2019 年 Beers 标准对 PIM 进行分类。在治疗开始后 3 个月内评估身体功能结果：（1）日常生活活动（ADL）下降：ADL 评分在基线和 3 个月之间下降 1 分；（2）工具性日常生活活动（IADL）下降：IADL 评分在基线和 3 个月之间下降 1 分；（3）短体适能电池（SPPB）下降，定义为 SPPB 下降 1 分；（4）在治疗后 3 个月内发生≥1 次跌倒。单独的多变量、聚类加权广义估计方程模型调整了相关协变量（例如，年龄、基线功能/合并症）。

结果

在 616 名参与者中，平均用药数为 6（范围 0-24）；28%的患者服用≥8 种药物。同时使用多种药物与 ADL 下降的风险增加相关（调整后的风险比 [aRR]，1.31；95%CI，1.00-1.71）。每使用一种符合 STOPP 的 PIM 与 IADL 下降的风险增加相关（aRR，1.21；95%CI，1.04-1.40）和跌倒的风险增加相关（aRR，1.93；95%CI，1.49-2.51）。