Zdravljenje z zdravili za obstruktivne pljučne bolezni pri bolnikih z novo odkritim nedrobnoceličnim rakom pljuč na Kliniki Golnik

Podgoršek, Eva (author), Knez, Lea (mentor), Morgan, Tina (co-mentor)

UVOD IN NAMEN: Rak pljuč in kronična obstruktivna pljučna bolezen (KOPB) imata podobne simptome ter dejavnike tveganja. Zaradi tega sta lahko bolezni prisotni sočasno ali pa se pri eni sprva pomisli na drugo. Namen raziskave je bil opisati, kako se uvaja in skozi čas spreminja inhalacijska terapija za zdravljenje obstruktivnih bolezni pljuč pri bolnikih z na novo diagnosticiranim nedrobnoceličnim rakom pljuč (NDRP), zdravljenim na Kliniki Golnik. Podrobneje smo opisali skupino, ki je imela inhalacijsko terapijo spremenjeno ali uvedeno na novo uvedeno tik pred diagnozo raka pljuč, vključno s pogostostjo neželenih učinkov inhalacijskih glukokortikoidov (IGK). METODE: V retrospektivno opazovalno raziskavo smo vključili bolnike z NDRP, ki so se v prvi liniji zdravljenja raka zdravili na Kliniki Golnik. Podatke smo pridobili s pomočjo bolnišničnega informacijskega sistema ter kliničnih poti sistemskega zdravljenja raka. REZULTATI: Izmed 298 vključenih bolnikov z NDRP so inhalacijsko terapijo tik pred diagnozo raka prejemali 104 bolniki (35 %). Največ bolnikov (29 %; 30/104) je prejemalo kombinacijo kratko- in dolgodelujočih bronhodilatatorjev ter IGK. Večina bolnikov (77 %; 80/104) je imela tik pred diagnozo NDRP inhalacijsko terapijo spremenjeno ali uvedeno na novo. Izmed vseh vključenih bolnikov je imel torej inhalacijsko terapijo spremenjeno ali uvedeno na novo vsak četrti bolnik (80/298; 27 %). Te bolnike (80) smo si pogledali podrobneje. Tik pred diagnozo raka pljuč so imeli inhalacijsko terapijo pogosteje uvedeno ali spremenjeno kadilci (hi-kvadrat test; p = 0,014), bolniki z obstruktivno boleznijo pljuč (hi-kvadrat; p = 0,001), bolniki z respiratornimi simptomi ob raku pljuč (hi-kvadrat; p < 0,001) ter bolniki s slabšo pljučno funkcijo (Mann-Whitney test; p < 0,001). Bolniki z novo uvedeno ali spremenjeno inhalacijsko terapijo so imeli najpogosteje uvedene kratkodelujoče bronhodilatatorje (24/80; 30 %). Diagnozo obstruktivne bolezni pljuč kot indikacijo za uvedbo inhalacijske terapije je imela večina bolnikov (63/80; 79 %). Bolniki so s časom pogosto opustili jemanje inhalacijske terapije. Pol leta po začetku zdravljenja raka je inhalacijsko terapijo prejemalo le še 56 % (40/72) bolnikov, poleg tega se je tekom časa število inhalacijskih učinkovin značilno zmanjševalo (Wilcoxonov test; p < 0,001). IGK je prejemalo 31/80 bolnikov z novo uvedeno ali spremenjeno inhalacijsko terapijo. Pri tem je imelo indikacijo za predpis IGK skupno 68 % (21/31) bolnikov z IGK, izmed tistih s sočasno KOPB pa le 53 % (9/17). Pri bolnikih z IGK smo opazili višjo pojavnost pljučnic (42 % v primerjavi z 29 % bolniki brez IGK) ter značilno pogostejšo pojavnost stomatitisa (hi-kvadrat; p = 0,038) ob sočasnem zdravljenju NDRP. ZAKLJUČEK: Bolniki z novo diagnosticiranim NDRP so imeli tik pred diagnozo raka inhalacijsko terapijo pogosto spremenjeno ali uvedeno na novo. Ker je bila uvedba inhalacijske terapije velikokrat le začasna in občasno brez ustrezne indikacije, predvidevamo, da je bila pogosto predpisana na račun respiratornih simptomov ob raku pljuč. Ker smo opazili višjo pojavnost stomatitisa in višjo pojavnost pljučnic pri bolnikih, ki so prejemali IGK, je pomembno, da se jih uvede le pri bolnikih, kjer korist pretehta tveganje.

• Language: Slovenian
• Keywords: Kronična obstruktivna pljučna bolezen, nedrobnocelični rak pljuč, spremembe v farmakoterapiji, inhalacijska terapija, neželeni dogodki zdravljenja z zdravili.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-146739
• Publication date in RUL: 10.06.2023

Secondary language

• Language: English
• Title: Treatment with drugs for obstructive lung disease in patients newly diagnosed with non-small cell lung cancer at the University Clinic Golnik

Abstract

INTRODUCTION AND AIMS: Lung cancer and chronic obstructive pulmonary disease (COPD) share similar symptoms and risk factors. For this reason, the two diseases may occur simultaneously, or one may initially be mistaken for the other. The purpose of this study was to describe how inhalation therapy for obstructive lung disease is introduced to treat patients with newly diagnosed non-small cell lung cancer (NSCLC) treated at the Golnik Clinic and how it changes over time. Specifically, we described the group with changes in inhalation therapy just prior to lung cancer diagnosis, including the occurrence of adverse effects of inhaled corticosteroids (ICS). METHODS: In this retrospective observational study, we included patients with NSCLC who received first-line cancer treatment at the Golnik Clinic. Data were collected using the hospital information system and clinical pathways of systemic cancer treatment. RESULTS: Of the 298 NSCLC patients included, 104 patients (35 %) were using inhalation therapy shortly before the cancer diagnosis. A combination of short-, long-acting bronchodilators and ICS (29 %; 30/104) was prescribed most frequently. Inhalation therapy of the majority of patients (77 %; 80/104) was initiated or intensified just before the NSCLC diagnosis. In other words, of all patients included, one in four patients (80/298; 27 %) had their inhaled therapy initiated or intensified. We looked at these patients (80) in more detail. Smokers (Chi-square test; p < 0,001), patients with obstructive lung disease (Chi-square test; p = 0,001), symptomatic patients (Chi-square test; p < 0,001), and patients with worse lung function (Chi-square test; p < 0,001) were significantly more likely to have inhalation therapy initiated or intensified shortly before the cancer diagnosis. Patients were most frequently prescribed short-acting bronchodilators (24/80; 30 %). Obstructive lung disease and therefore a treatment indication for inhalation therapy was present in 63 of 80 (79 %) patients. Over time, patients frequently discontinued inhalation therapy; only 56 % (40/72) of patients were still receiving inhalation therapy six months after starting cancer treatment. The number of inhalation agents also decreased significantly over time (Wilcoxon test; p < 0,001). Inhaled corticosteroids (ICS) were prescribed to 31 of 80 patients. Overall, 68 % (21/31) of patients with ICS had a treatment indication for ICS prescription, whereas only 53 % (9/17) of patients with concurrent COPD did. In patients with ICS, a trend towards a higher incidence of pneumonia (42 % vs. 29 % of patients without ICS) and a significantly higher incidence of oral candidiasis (Chi-square test; p = 0,038) was observed. CONCLUSIONS: Inhalation therapy for obstructive lung disease was frequently introduced to or intensified in patients with newly diagnosed NSCLC. Because the introduction of inhalation therapy for was often temporary and occasionally without a treatment indication, we hypothesize that inhalation therapy was often prescribed at the expense of respiratory symptoms in lung cancer. Because patients receiving ICS were significantly more likely to develop oral candidiasis and showed a trend towards a higher incidence of pneumonia, it is important to prescribe ICS only to patients in whom the benefit outweighs the risk.

• Keywords: Chronic obstructive pulmonary disease, non-small cell lung cancer, changes in pharmacotherapy, inhalation therapy, adverse drug events.