Prevalence of Proton Pump Inhibitor Use Among Patients With Cancer

Abstract

The cancer armamentarium is evolving with evidence of the efficacy of oral treatments. Their mode of administration is simple and convenient, but absorption is influenced by diet and gastric pH.Moreover, the efficacy of checkpoint inhibitors (CPIs) depends on the gut microbiome. Proton pump inhibitors (PPIs), which are among the most widely prescribed drugs, decrease the bioavailability of oral cancer treatments, lowering their efficacy, 1-4 and induce major microbial alterations in the gut. 4 We conducted a study to evaluate the prevalence of PPI prescribing, to identify the factors associated with PPI prescription, and to focus on patients receiving tyrosine kinase inhibitors (TKIs), CPIs, and capecitabine. MethodsThis cross-sectional study was conducted in 4 French Comprehensive Cancer Centers from June 15 to 19 and from June 22 to 26, 2020. It was approved by the ethics committee of Angers University, which waived the need for informed consent in accordance with university policy. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Volunteer physicians collected data from patients with cancer seen in consultation or in the Same Day Unit. An information sheet (explaining the goals of the study, that patients could refuse to participate, and that all data would be anonymized) was given to patients; those who accepted were included. The physicians then completed a form (with scrolling menu) based on the patient's medical records and answers to a few questions.Parameters were compared using Welch t test, χ 2 test, or Fisher exact test as appropriate.Significant parameters were entered into a multivariable logistic regression with a stepwise procedure. All P values were 2-sided with P < .05 considered significant. Statistical analyses were performed with R statistical software version 4.0.2 (R Project for Statistical Computing). ResultsIn total, 872 complete and verified (data manager) forms corresponding to 566 women ( 64.9%) and 306 men (35.1%) (median [range] age, 63 [20-91] years) (Table 1) were recorded. Among these, 229 patients (26.3%) were taking PPIs on the day of inclusion. Most patients who used PPIs did so on a regular basis (163 patients [71.1%]), at normal dosage (154 patients [67.2%]), for epigastric pain (114 patients [50.0%]), retrosternal pain (32 patients [14.0%]), proven esophageal or gastric ulcer (18 patients [8.0%]), or gastroprotection (34 patients [15.0%]).

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