1. Non-Statin Users % (n=247)
Prevalence and factors associated with statin use in geriatric oncology
Justin P. Turner1,2, Sepehr Shakib3, Nimit Singhal4, Jonathon Hogan-Doran4, Robert Prowse5, Sally Johns3, J. Simon Bell1,2
1. School of Pharmacy and Medical Sciences, University of South Australia, 2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 3. Clinical Pharmacology, Royal Adelaide Hospital, 4. Medical Oncology, Royal Adelaide Hospital, 5. Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital
Background:
With older age and reduced life expectancy the harms of long-term preventative medications may outweigh the benefits.
There is minimal evidence that statins reduce mortality in people aged ≥80 years.
Recent evidence suggests statins are associated with increased pain and musculoskeletal conditions.
Objective:
To investigate the prevalence and factors associated with statin use and pain in people aged <80 years and ≥80 years
Methods:
Between January 2009 and June 2010, 385 patients attended the geriatric oncology outpatient clinic at the Royal Adelaide Hospital
27.5% (n=106) were aged ≥ 80 years.
Each patient completed measures of pain (10 point visual analogue scale [VAS]), medication use and comorbidities.
Unadjusted and adjusted logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between statin use and clinical parameters.
Results:
The point prevalence of statin use was 34.8% (n=97) in people aged <80 years and 38.7% (n=41) in people ≥80 years.
After adjusting for age, gender, analgesic use and Charlson Comorbidity Index (CCI), statin use was associated with higher prevalence of patient self reported pain (VAS ≥5) than non-use (OR 4.09 [95% CI ]) in people aged ≥80 years, but not in people <80 years.
There were 41 statin users aged ≥80 years, with 49% (n=20) using statins for primary prevention. Of those 60% (n=12) had a palliative treatment intent.
Statin use for secondary prevention accounted for 51% (n=21) of statin users, with 57% (n=12) having a palliative treatment intent.
Conclusion:
The prevalence of statin use was similar in people aged <80 years and ≥80 years, with statin use associated with self-reported pain in people aged ≥80 years.
This highlights the potential value of deprescribing statins in the geriatric oncology setting, particularly when benefit is likely to be minimal and ADEs are present.
Acknowledgements:
We would like to thank the staff of the geriatric oncology outpatient clinic at the Royal Adelaide Hospital for their generous support, participation and dedication to data collection.
Table2: Unadjusted and adjusted odds ratios for factors associated with statin use
<80 years
≥ 80 years
Unadjusted OR (95% CI)
Adjusted OR (95% CI)
Age
0.99 ( )
0.98 ( )
0.87 ( )
0.85 ( )
Male gender
1.42 ( )
1.19 ( )
1.15 ( )
1.15 ( )
Pain Score ≥5
1.02 ( )
0.96 ( )
3.18 ( )
4.09 ( )
CCI
1.49 ( )
1.47 ( )
1.52 ( )
1.60 ( )
Analgesic use
0.79 ( )
0.72 ( )
0.98 ( )
0.86 ( )
CCI = Charlson Comorbidity Index
Table1: Characteristics of patients attending the geriatric oncology outpatient clinic
All Patients % (n=385)
Non-Statin Users % (n=247)
Statin Users % (n=138)
P Value
Age*
76.7 (4.8, 70-92)
76.7 ( )
76.7 (4.7, 70-90)
P=0.910+
<80
72.4% (279)
65.2% (182)
34.8% (97)
≥80
27.6% (106)
61.3% (65)
38.7% (41)
P=0.475#
Male gender
59.0% (227)
56.3% (139)
63.8% (88)
P=0.152#
Treatment intent;
Non-palliative
51.7% (199)
53.0% (131)
49.3% (68)
P=0.480#
Palliative
48.3% (186)
47.0% (116)
50.7% (70)
Clinical Parameters;
Pain Score ≥5 (n=381)
26.0% (99)
23.8% (58)
29.9% (41)
P=0.189#
CCI* (n=385)
1.2 (1.4, 0-6)
1.0 (1.3, 0-6)
1.7 (1.4, 0-6)
P<0.001+
Analgesic use
35.3% (136)
36.8% (91)
32.6% (45)
P=0.406#
* Mean (SD, range), +Mann-Whitney U Test, #Pearson Chi-Square, CCI = Charlson Comorbidity Index