老年癌症患者潜在不适当用药发生率的Meta分析
Prevalence of Potentially Inappropriate Medication in Older Adults with Cancer：a Metaanalysis
背景 老年癌症患者中普遍存在多病、多药现象，导致患者容易出现潜在不适当用药（PIM），从而对患者预后产生不利影响。目的 系统评价老年癌症患者 PIM 发生率。方法 计算机检索中国知网、维普网、中国生物医学文献数据库、万方数据知识服务平台、PubMed、Embase、Web of Science 和 Cochrane Library 数据库中有关老年癌症患者 PIM 发生现状的相关研究，检索时间为建库至 2024 年 9 月。2 位研究者对所检文献进行独立筛选、数据提取以及偏倚风险评价，并使用 Stata 17.0 软件进行 Meta 分析。结果 最终纳入 36 篇文献、共 54 组 PIM 发生率，包含95 290 例患者。Meta 分析结果显示，老年癌症患者 PIM 发生率为 44.5%（95%CI=39.2%~49.8%）。亚组分析结果显示，60~70 岁、>70 岁的老年癌症患者 PIM 发生率分别为 44.4%、46.1%；老年男性、女性癌症患者 PIM 发生率分别为40.9%、42.5%；疾病数量≤ 5 种、>5 种的老年癌症患者 PIM 发生率分别为 34.4%、47.1%；用药数量≥ 5 种、<5 种的老年癌症患者 PIM 发生率分别为 39.9%、30.4%；肺癌、胃肠癌、血液恶性肿瘤、乳腺癌和前列腺癌患者 PIM 发生率分别为 45.6%、39.4%、42.0%、39.4% 和 42.6%；亚洲、欧洲、北美洲和南美洲的老年癌症患者 PIM 发生率分别为50.2%、45.8%、35.7% 和 51.4%；样本取自医院、数据库、丹娜法伯癌症研究所和癌症中心的老年癌症患者 PIM 发生率分别为 47.6%、43.0%、34.6% 和 34.5%；Beers 标准、DAE、STOPP/START 标准、EU（7）-PIM list 和中国 PIM 标准（2017版）筛查的老年癌症患者 PIM 发生率分别为 46.6%、16.5%、44.6%、60.0% 和 39.3%；2020 年及之前、2020 年之后发表的老年癌症患者 PIM 发生率分别为 36.1%、52.5%。结论 老年癌症患者 PIM 发生率较高，为 44.5%。应重视预防、筛查和干预相关人群中的潜在用药不当，为癌症老年人的健康奠定坚实的基础。
Background The increasing phenomena of multimorbidity and polypharmacy in older adults with cancer predisposes them to potentially inappropriate medicationPIMwhich adversely affects patient prognosis. Objective To systematically evaluate the prevalence of PIM in older adults with cancer. Methods The Cochrane LibraryWeb of ScienceEmbasePubMedCNKIVIPWanfang Dataand CBM databases were searched to collect studies related to the prevalence of PIM in older adults with cancerand the search period was from the inception of the databases to September 2024. The examined literature was independently screeneddata extractedand evaluatedand Stata 17.0 software was used to perform meta-analysis. Results A total of 36 studies with 54 prevalence estimates were analyzedincluding 95 290 patients. Meta analysis indicated that the prevalence of PIM in older adults with cancer was 44.5%95%CI=39.2%~49.8%. The results of subgroup analysis showed that the prevalence of PIM in older adults with cancer aged 60-70 and >70 years was 44.4% and 46.1%respectivelythe prevalence of PIM in elderly male and female patients was 40.9% and 42.5%respectivelythe prevalence of PIM in patients with 5 and >5 diseases was 34.4% and 47.1%respectivelythe prevalence of PIM in patients with 5 and <5 medications was 39.9% and 30.4%respectivelythe prevalence of PIM in patients with lung cancergastrointestinal cancerhematologic malignanciesbreast cancerand prostate cancer was 45.6%39.4%42.0%39.4%and 42.6%respectivelythe prevalence of PIM in patients from hospitalsdatabasesDana-Farber Cancer Instituteand cancer centers was 47.6%43.0%34.6%and 34.5%respectivelythe prevalence of PIM screened by the Beers criteriaDAESTOPP/START criteriaEU7-PIM listand the 2017 Chinese criteria was 46.6%16.5%44.6%60.0%and 39.3%respectivelythe prevalence of PIM published in 2020 and before and after 2020 was 36.1% and 52.5%respectively.Conclusion The prevalence of PIM is relatively high in older adults with cancerat 44.5%. The preventionscreeningand intervention of potential inappropriate medication among relevant populations should be emphasized to lay a solid foundation for the health in older adults with cancer.
许佳兰、阎红、文君、周紫彤、王思宇
医药卫生
潜在不适当用药癌症老年人发生率Meta 分析
许佳兰,阎红,文君,周紫彤,王思宇.老年癌症患者潜在不适当用药发生率的Meta分析[EB/OL].(2025-02-12)[2025-03-14].https://chinaxiv.org/abs/202502.00068.点此复制
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