Decreasing Polypharmacy in Older Adults with Curable Cancers

项目摘要/摘要 多药联用(PP)，或同时使用多种药物，影响高达92%的患有 癌症。它与这些患者的不良后果有关，包括依从性差和 对癌症治疗的耐受性，身体功能下降，计划外住院，跌倒，增加 症状和较低的存活率。“停药”，或有计划地停止用药，这可能是 可能不安全或不适当，是一种干预策略，有可能降低PP和 改善结果。在接受化疗的老年癌症患者中，还没有研究过停药。 考虑到PP与化疗的相对剂量强度(RDI)降低的相关性，剂量比 接受标准剂量的停药干预可以改善患有癌症的老年人的RDI 接受治疗性化疗；化疗的RDI是这些患者生存的预测因素。这 提案提出了一个五年研究和职业发展计划，重点是调查 非处方干预在老年PP和PP患者中的初步疗效和最佳实施 可治愈的癌症。候选人埃里卡·拉姆斯代尔博士是加州大学医学院助理教授。 罗切斯特，并在肿瘤学和老年医学方面获得董事会认证。这项建议是在她先前的基础上提出的。 研究表明PP在接受化疗的老年人中很普遍，药剂师领导的 取消处方干预在肿瘤科门诊实施是可行的，患者满意度较高。目标 拟议研究的内容是：1/调整和改进潜在的可扩展的停药干预措施；2/调查 非处方干预对接受根治性治疗的老年人RDI及其他不良结局的影响 意向化疗，以及3/确定患者停药干预的障碍和促进者， 肿瘤学家和药剂师。焦点小组和对药剂师、肿瘤学家、护士、初级医生的采访 护理提供者和患者倡导者将允许对拟议的干预措施进行初步调整。一位“试飞员” 计划接受治疗性化疗的8名PP和癌症患者将接受 药剂师指导的停药干预和额外的迭代适应。那么，72名患者将被 分配给药剂师领导的停药干预与患者教育干预- 12个肿瘤学家分组的随机试验。该提案描述了一项全面的指导和培训 计划发展临床试验设计、实施科学和数据科学方面的互补技能 (包括信息学和统计学)。在她的主要导师Supriya Mohile博士的指导下，共同- 导师Gary Morrow博士、Lisa Zubkoff博士和Holly Holmes博士，以及顾问Sally Norton博士和Martin博士 赞德，她将在这些领域提升自己的技能，长期目标是成为一名独立的巨蟹座 护理提供研究人员实施和测试多层次干预措施，包括技术干预措施， 以解决患有癌症的老年人的多药问题。

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.