老年肿瘤患者潜在不适当用药的现状及应对策略

doi:10.12114/j.issn.1007-9572.2023.0407

摘要/Abstract

摘要： 越来越多的研究证明潜在不适当用药（PIM）在老年肿瘤患者中普遍发生，并且相较于普通老年人，肿瘤患者PIM发生率可能更高，并且对患者预后产生不良影响，因此有必要对既往研究进行系统全面的总结分析，为后续的进一步研究提供支持和参考。本文通过系统检索PubMed、中国知网和万方数据知识服务平台，对肿瘤患者PIM的审查工具、PIM发生率、主要涉及的药物、影响因素，以及PIM与各种不良结局之间的关系进行总结与分析。研究表明，不同的PIM审查工具在调查老年肿瘤患者PIM发生率时存在差异，而《NCCN临床实践指南：老年肿瘤（2020.v2）》中提供的老年患者慎用的支持治疗药物列表在为肿瘤患者提供个体化药物管理方面表现出了优势。多重用药、年龄、合并症等与PIM的发生显著相关，苯二氮类药物和镇痛类药物是肿瘤患者使用较多的高风险药物。存在PIM的老年肿瘤患者可能具有较高的死亡率、药物相互作用发生率、不良事件发生率、急诊及住院再就诊率等。希望本文能够为国内进行老年肿瘤患者PIM相关的研究提供参考，并为促进老年肿瘤人群安全合理用药提供支持。

关键词: 潜在不适当用药, 多重用药, 肿瘤患者, 老年人, 不良结局

Abstract:

An increasing number of studies have demonstrated that potentially inappropriate medication (PIM) occurs commonly in elderly patients with cancer, with higher prevalence of PIM than general elderly, which may lead to adverse effects on prognosis of the patients. Therefore, it is necessary to conduct a systematic and comprehensive review of previous studies to provide support and reference for future studies. PubMed, CNKI and Wanfang Data were systematically searched to summarize and analyze the screen tools of PIM, prevalence of PIM, main drugs involved, influencing factors and the relationship between PIM and adverse outcomes. The results showed that the prevalence of PIM varied when different PIM screen tools were used in older patients with cancer, and the list of medications commonly used for supportive care that are of concern in older patients provided by the NCCN Guidelines for Older Adult Oncology (2020.v2) demonstrated advantages in providing individualized medication management for elderly patients with cancer. Polypharmacy, age, and comorbidities were significantly associated with the development of PIM. Benzodiazepines and analgesics are commonly used as high-risk drugs in elderly patients with cancer. PIM may be associated with higher mortality rates, drug interaction rates, adverse event rates, emergency and hospital readmission rates in elderly patients with cancer. It is hoped that this article will provide a reference for conducting studies related to PIM in elderly patients with cancer in China and provide support for promoting the safe and rational use of medication in elderly patients with cancer.

Key words: Potentially inappropriate medication, Polypharmacy, Cancer patients, Aged, Adverse outcomes

徐曼,安卓玲,张予辉,等. 老年肿瘤患者潜在不适当用药的现状及应对策略[J]. 中国全科医学, 2023, 26(35): 4382-4387. DOI: 10.12114/j.issn.1007-9572.2023.0407.
XU Man,AN Zhuoling,ZHANG Yuhui, et al. Current Situation of Potentially Inappropriate Medication in Older Cancer Patients and Strategies to Address It[J]. Chinese General Practice, 2023, 26(35): 4382-4387. DOI: 10.12114/j.issn.1007-9572.2023.0407.

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