Medication regimen complexity in cancer patients: an overlooked issue for healthcare team

Abstract

Purpose: This study aimed to evaluate the complexity of medication in patients with cancer and to explore its impact on the duration of hospital stay, patients’ perceived medication burden, adherence and unplanned hospitalizations after discharge. Methods: This study was prospectively conducted in medical oncology clinics of a tertiary care hospital. Patients over 18 years of age and diagnosed with solid tumors and deemed non-palliative were included. A clinical pharmacist assessed the patient’s medication regimen complexity using Medication Regimen Complexity Index (MRCI) upon admission, at 48 hours of hospitalization and at discharge. Clinical pharmacist also participated in the patient education provided by the multidisciplinary team at discharge. Patients' adherence was assessed by Medication Adherence Reporting Scale (MARS) at admission and at the first outpatient visit after the discharge. The perceived burden of drug treatment by the patients was assessed using a questionnaire named as Medication Complexity Questionnaire from Patient Perspective (MCQPP) that was designed by the researchers. The questionnaire was administered at the first follow-up visit at the outpatient clinic after the discharge. Unplanned hospitalizations of the patients within 30 days after discharge were also examined. Results: A total of 147 patients were enrolled. The median (IQR) MRCI score at discharge was 15.0 (11.0 – 22.0), which was significantly higher than the MRCI score at admission, which was 11.0 (7.0 – 15.0) (p<0.001). As a result of the patient education provided at discharge by the multidisciplinary team, a statistically significant increase was observed in treatment adherence of the patients. Median (IQR) MARS score assessed at admission was 19 (15 – 23), while it increased to 20 (16 – 23) at the follow up outpatient visit (p=0.003). Complexity was found to be higher in patients who had more negative perceptions about their medication, in patients who reported that their daily life were significantly affected by their medication, and in those who perceived more significant burden when complex instructions for medication use were evident (p<0.001). The median MRCI scores at discharge were higher in patients with unplanned hospitalizations compared to those without hospitalization (p<0.001). Conclusions: In conclusion, integrating the MRCI into oncology practices, along with multidisciplinary care that includes clinical pharmacists, may enable identification of high-risk patients, individualization of drug treatment and optimization of treatment process.