A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer

Nightingale, Ginah; Hajjar, Emily R.; Guo, Krystal; Komura, Stephanie; Urnoski, Eric; Sendecki, Jocelyn; Swartz, Kristine; Chapman, Andrew E.

doi:10.1016/j.jgo.2015.07.003

Cited by 40 publications

(31 citation statements)

References 26 publications

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“…In another multicenter cross‐sectional study, PP was associated with clinical depression (OR, 1.6; 95% CI, 1.1–2.3; p = .008) . PP was also associated with use of complementary and alternative medications (OR, NR; 95% CI, NR; p = .04) and caregiver burden (OR, 2.2; 95% CI, 1.1–4.3; p = .02) . PP was not associated with impaired geriatric assessment domains using the Geriatric 8 screening tool, nor with radiation treatment completion or change in cancer treatment plan .…”

Section: Discussionmentioning

confidence: 97%

“…Survival outcomes were assessed in 12/47 studies (26%; Table ) . Other outcomes (e.g., medication adherence, caregiver burden and alternative medications use; supplemental online Table 3) .…”

Section: Discussionmentioning

confidence: 99%

“…See Table . Among 11 studies , three demonstrated an association between PIM and clinical outcomes. In a single center retrospective study of 171 patients with aggressive non‐Hodgkin lymphoma, PIM use by Beers criteria was associated with grade ≥ 3 toxicity (HR, 1.02; 95% CI, 1.00–1.04; p = .01), worse progression‐free survival (HR, 2.81; 95% CI, 1.4–5.8; p = .005), and higher mortality (HR, 3.12; 95% CI, 1.5–6.5; p = .003) .…”

Section: Discussionmentioning

confidence: 99%

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Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

et al. 2019

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Background Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta‐analysis, obtains estimates of postoperative outcomes associated with PP in this population. Materials and Methods We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross‐sectional studies, meta‐analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. Results Forty‐seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta‐analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3–2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. Conclusion PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies. Implications for Practice Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

et al. 2019

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“…Participants taking OGLM were less likely to use CM. Based on previous studies in the elderly, 22 this may not be a consequence of a high tablet burden, but could be a reflection of the desire of people with diabetes managed through lifestyle (mainly diet) and not OGLM to view CM as a non-pharmaceutical way of avoiding therapeutic progression. 23 We found an inverse independent association between HbA 1c levels and CM use.…”

Section: Discussionmentioning

confidence: 99%

Complementary medicine use and its cost in Australians with type 2 diabetes: the Fremantle Diabetes Study Phase II

Yarash

Sharif

Masood

et al. 2020

Internal Medicine Journal

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Background Few studies have examined complementary medicine (CM) use in diabetes. Australian data are inconsistent, limited in scope and have not considered cost. Aims To evaluate the prevalence, associates and costs of CM in a contemporary Australian urban, community‐based cohort of people with type 2 diabetes. Methods Baseline CM use was determined as part of a detailed assessment in 1543 of 1551 Fremantle Diabetes Study Phase II (FDS2) participants with type 2 diabetes (mean age 65.7 years, 51.8% males, median diabetes duration 9.0 years) recruited to the FDS2 between 2008 and 2011 who self‐reported medication use including CM defined as non‐prescription medicinal products. Results A total of 672 FDS2 type 2 participants (43.6%) used at least one type of CM, 92% of which were nutritional supplements (omega‐3 fatty acids/fish oil in 24% of CM users followed by calcium in 11%, glucosamine in 10% and others in <10%). Independent associates of CM use included older age, female sex, any mobility problem, and, inversely, Southern European or Indigenous Australian background, lack of English fluency, ex/current smoking status, taking oral glucose‐lowering medications and higher HbA1c. The total annual estimated cost of CM used by FDS2 participants with type 2 diabetes was A$121 640 or A$79 ± 208 per person (range A$0–2993). Extrapolating these data, the 1 million Australians with type 2 diabetes spend A$79 million/year on CM. Conclusions CM use in type 2 diabetes is both common and costly. Healthcare professionals should consider discussing safe and cost‐effective use of CM with their patients with type 2 diabetes.

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“…A high-quality GA should therefore include a full medication reconciliation and individualized evaluation of appropriateness of a patient’s entire medication regimen; both prescription and non-prescription including supplements and complementary and alternative medicines (CAM). Complementary and alternative medicine use is a potential source of polypharmacy and drug-drug interactions [21]. Moreover, several cross-sectional studies in geriatric oncology have demonstrated that older patients with cancer are routinely exposed to polypharmacy, or excess medication use, and unnecessary and inappropriate medications, defined as medications with a high risk to benefit ratio [19, 22, 23••, 24, 25].…”

Section: Geriatric Assessment As a Supportive Care Strategymentioning

confidence: 99%

Supportive Care in Older Adults with Cancer: Across the Continuum

et al. 2016

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Supportive care is an essential component of anti-cancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anti-cancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.

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A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer

Cited by 40 publications

References 26 publications

Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

Complementary medicine use and its cost in Australians with type 2 diabetes: the Fremantle Diabetes Study Phase II

Supportive Care in Older Adults with Cancer: Across the Continuum

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