Development and validation of a nomogram to predict the risk of potentially inappropriate medication use in older lung cancer outpatients with multimorbidity

ABSTRACT

Background

At present, there is no predictive model that can predict the prevalence of potentially inappropriate medication (PIM) use in older lung cancer outpatients.

Research design and methods

We measured PIM by the 2019 Beers criteria. Significant factors were identified to develop the nomogram using logistic regression. We validated the nomogram internally and externally in two cohorts. The discrimination, calibration, and clinical practicability of the nomogram were verified using receiver operating characteristic (ROC) curve analysis, Hosmer-Lemeshow test, and decision curve analysis (DCA), respectively.

Results

A total of 3300 older lung cancer outpatients were divided into a training cohort (n = 1718) and two validation cohorts, including an internal validation cohort (n = 739) and an external validation cohort (n = 843). A nomogram for predicting PIM use patients was developed using six significant factors. ROC curve analysis showed that the area under the curve was 0.835 in the training cohort and 0.810 and 0.826 in the internal validation and external validation cohorts, respectively. The Hosmer‒Lemeshow test yielded P = 0.180, 0.779 and 0.069, respectively. The nomogram demonstrated a high net benefit in DCA.

Conclusions

The nomogram could be a convenient, intuitive, and personalized clinical tool for assessing the risk of PIM in older lung cancer outpatients.

KEYWORDS:

• Potentially inappropriate medication
• polypharmacy
• lung cancer
• older
• nomogram

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

All data generated or analyzed during this study can be obtained from the corresponding author upon inquiry.

Author contributions

Study concept and design: F Tian. Acquisition of data: Z Chen. Analysis and interpretation of data: B Wu. Drafting of the manuscript: F Tian. Critical revision of the manuscript for important intellectual content: F Tian and Z Chen.

Ethics statement

The study was approved by the Sichuan University West China Hospital Research Ethics Board.

Additional information

Funding

This work was supported by the Sichuan Geriatrics Healthcare Program (Project number: 2023-124) and Sichuan Science and Technology Program (Project number: 2022JDR0326, 2023JDR0246).