Decreasing Polypharmacy in Older Adults with Curable Cancers

项目总结/摘要 多药治疗（PP）或同时使用多种药物，影响高达92%的老年人， 癌它与这些患者的不良结局有关，包括依从性差和 癌症治疗耐受性、身体功能下降、计划外住院、福尔斯、增加 症状和较低的生存率。“取消处方”，或计划停用可能 可能不安全或不适当的，是一种有可能降低PP的干预策略， 改善成果。尚未在接受化疗的老年癌症患者中进行过停药研究。 考虑到PP与化疗相对剂量强度（RDI）降低的相关性， 接受标准剂量，取消处方干预可以改善老年癌症患者的RDI 接受治愈性化疗;化疗的RDI是这些患者生存的预测因子。这 该提案提出了一项五年研究和职业发展计划，重点是调查 在老年PP患者中取消处方干预的初步疗效和最佳实施， 可治愈的癌症候选人Erika Ramsdale博士是密歇根大学医学助理教授。 罗切斯特，并在肿瘤学和老年医学委员会认证。这一提议建立在她先前的 研究表明，PP在接受化疗的老年人中很普遍， 取消处方干预在患者满意度高的肿瘤诊所中实施是可行的。目标 拟议研究的目的是：1/调整和完善潜在的可扩展的取消处方干预措施; 2/调查 取消处方干预对接受治疗的老年人RDI和其他不良结局的影响- 意向化疗，3/确定患者取消干预措施的障碍和促进因素， 肿瘤学家和药剂师焦点小组和与药剂师，肿瘤学家，护士，初级 护理提供者和病人倡导者将允许对拟议的干预措施进行初步调整。一个“准飞行员” 计划接受治愈性化疗的8例PP和癌症患者的队列将接受 药剂师主导的取消处方干预与额外的迭代调整。72名患者将 分配到一个群集中的药剂师主导的取消处方干预与患者教育干预- 12个肿瘤学家群的随机试验。该提案描述了全面的指导和培训 计划发展临床试验设计、实施科学和数据科学方面的补充技能 （包括信息学和统计学）。在她的主要导师Supriya Mohile博士的指导下， 导师加里莫罗博士、丽莎祖布科夫博士和冬青霍姆斯博士，顾问萨利诺顿博士和马丁博士 赞德，她将推进她的技能，在这些领域的长期目标，成为一个独立的癌症 护理提供研究人员实施和测试多层次的干预措施，包括技术干预措施， 来解决老年癌症患者的多种药物治疗问题。

PROJECT SUMMARY/ABSTRACT Polypharmacy (PP), or the concurrent use of multiple medications, affects up to 92% of older adults with cancer. It has been associated with adverse outcomes in these patients including poor adherence to and tolerance of cancer therapy, decrease in physical functioning, unplanned hospitalizations, falls, increased symptoms, and lower survival. “Deprescribing,” or the planned discontinuation of medications which may be potentially unsafe or inappropriate, is an intervention strategy which has the potential to decrease PP and improve outcomes. Deprescribing has not been studied in older adults with cancer receiving chemotherapy. Given the association of PP with reduced relative dose intensity (RDI) of chemotherapy, a ratio of dosing received to standard dosing, a deprescribing intervention could improve RDI in older adults with cancer receiving curative-intent chemotherapy; RDI of chemotherapy is a predictor of survival in these patients. This proposal presents a five-year research and career development plan focused on investigating both the preliminary efficacy and the optimal implementation of deprescribing interventions in older adults with PP and curable cancers. The candidate, Dr. Erika Ramsdale, is an Assistant Professor of Medicine at the University of Rochester and is board-certified in both Oncology and Geriatric Medicine. This proposal builds upon her prior work demonstrating that PP is prevalent in older adults receiving chemotherapy and that a pharmacist-led deprescribing intervention is feasible to implement in an oncology clinic with high patient satisfaction. The aims of the proposed study are: 1/adapt and refine potentially scalable deprescribing interventions; 2/investigate the effects of deprescribing interventions on RDI and other adverse outcomes in older adults undergoing curative- intent chemotherapy, and 3/identify barriers and facilitators of deprescribing interventions for patients, oncologists, and pharmacists. Focus groups and interviews with pharmacists, oncologists, nurses, primary care providers, and patient advocates will allow initial adaptation of the proposed interventions. A “pre-pilot” cohort of 8 patients with PP and cancer planned to receive curative-intent chemotherapy will undergo a pharmacist-led deprescribing intervention with additional iterative adaptations. Then, 72 patients will be allocated to a pharmacist-led deprescribing intervention versus patient education intervention in a cluster- randomized trial of 12 oncologist clusters. The proposal describes a comprehensive mentorship and training plan to develop complementary skills in clinical trial design, implementation science, and data science (encompassing informatics and statistics). Under the guidance of her primary mentor Dr. Supriya Mohile, co- mentors Dr. Gary Morrow, Dr. Lisa Zubkoff, and Dr. Holly Holmes, and advisors Dr. Sally Norton and Dr. Martin Zand, she will advance her skills in these areas with the long-term goal of becoming an independent cancer care delivery researcher implementing and testing multi-level interventions, including technology interventions, to address polypharmacy in older adults with cancer.