Polypharmacy and Malnutrition Management of Elderly Perioperative Patients with Cancer: A Systematic Review

Abstract

Malnutrition, which commonly occurs in perioperative patients with cancer, leads to decreased muscle mass, hypoalbuminemia, and edema, thereby increasing the patient’s risk of various complications. Thus, the nutritional management of perioperative patients with cancer should be focused on to ensure that surgical treatment is safe and effective, postoperative complications are prevented, and mortality is reduced. Pathophysiological and drug-induced factors in elderly patients with cancer are associated with the risk of developing malnutrition. Pathophysiological factors include the effects of tumors, cachexia, and anorexia of aging. Metabolic changes, such as inflammation, excess catabolism, and anabolic resistance in patients with tumor-induced cancer alter the body’s ability to use essential nutrients. Drug-induced factors include the side effects of anticancer drugs and polypharmacy. Drug–drug, drug–disease, drug–nutrient, and drug–food interactions can significantly affect the patient’s nutritional status. Furthermore, malnutrition may affect pharmacokinetics and pharmacodynamics, potentiate drug effects, and cause side effects. This review outlines polypharmacy and malnutrition, the impact of malnutrition on drug efficacy, drug–nutrient and drug–food interactions, and intervention effects on polypharmacy or cancer cachexia in elderly perioperative patients with cancer.

Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

“…The leading causes were angiotensinconverting enzyme inhibitors (ACEI) and HMG-CoA reductase inhibitors (statins), which are commonly prescribed for hypertension and dyslipidemia patients. In addition, as reported in a recent systematic review [90], adverse drug reactions, including drug-drug interactions and drug-nutrient interactions, can influence nutritional status, frailty, and cognitive impairment when using between two and 11 medications. For example, frailty and cognitive impairment can be caused by the drug-nutrient interactions of statins on coenzyme Q 10 deficiency and metformin on vitamin B 12 deficiency.…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…(Figure 1). PRO may also help cancer patients and caregivers to better sort out major versus minor contributors to eating behavior and well-being as well as staying "ontrack" during treatment and avoiding polypharmacy or worse: ineffective, and potentially harmful supplements and unproven alternative treatments [41,74,[128][129][130][131][132]169].…”

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”

The Role of Nutritional Status on Polypharmacy, Cognition, and Functional Capacity of Institutionalized Elderly: A Systematic Review

“…Twenty to thirty percent of older adults take more than four medications, whereas nursing home senior residents take more than eight drugs per day [ 15 ]. Moreover, polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly [ 16 , 17 ].…”