Managing Polypharmacy in Older Adults with Cancer Across Different Healthcare Settings

Abstract

The care of older patients with cancer is becoming increasingly complex. Common challenges for this population include management of comorbidities, safe transitions of care, and appropriate medication use. In particular, polypharmacy—generally defined as the regular use of five or more medications—and inappropriate medication use can lead to adverse effects and poor outcomes in older adults with cancer, including falls, hospital readmissions, cognitive impairment, poor adherence to essential medications, chemotherapy toxicity, and increased mortality. Managing polypharmacy across different cancer care settings is often challenging. Providers face barriers to safe and successful medication management that may include lack of time, absence of reimbursement, underappreciation of the scale of polypharmacy-related harm, lack of ownership of deprescribing efforts, and poor communication across care settings. Existing literature on managing inappropriate medication use and polypharmacy in older adults with cancer has often focused on ideal state settings in which resources are plentiful and time is purposefully allocated for medication interventions. This paper presents a narrative, rather than a systematic review, of studies published in the past decade that provided detailed information on medication management and polypharmacy across cancer care settings. This review aims to also summarize different healthcare provider roles in taking action against inappropriate medication use and polypharmacy in older adults with cancer.

Genophenotypic Factors and Pharmacogenomics in Adverse Drug Reactions

“…Although many recommendations and guidelines have been proposed from many good-will sources, PGx has not been introduced in geriatric medicine with enough determination to fight the dangerous pandemic of polypharmacy-related ADRs in the elderly [54][55][56][57][58].…”

The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes

“…The existing body of literature supports pharmacist involvement in PP and PIM assessment, deprescribing interventions, drug–drug interaction reviews, and immunization recommendations. Despite some supporting data, these pharmacist-led studies lack clinical outcome measures and PROMs, warranting future study 32,33▪. Randomized studies are needed to evaluate the impact of oncology pharmacist interventions on certain outcomes measures.…”

How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

“…Polypharmacy in older adults with cancer increases the risk of potentially inappropriate medication (PIM) use, defined as using a medication in which risks outweigh potential benefits, occurring from continuing a medication that is no longer necessary or where safer alternatives exist [3]. Polypharmacy and PIM use are associated with adverse drug events, frailty, falls, cognitive impairment, chemotherapy toxicity, postoperative complications, unplanned hospitalizations, and mortality [4,5]. Both polypharmacy and PIM also increase the risk of drug interactions and influence medication adherence [6].…”