Polypharmacy and Potentially Inappropriate Medication Use in Older Adults with Cancer Undergoing Chemotherapy: Effect on Chemotherapy‐Related Toxicity and Hospitalization During Treatment

Abstract

Polypharmacy and potentially inappropriate medication (PIM) use are understudied among older adults with cancer undergoing chemotherapy. The current study’s aims were to evaluate in this population: 1) the prevalence of polypharmacy and PIM use; and 2) the association between these and chemotherapy-related adverse events. Methods This was a secondary analysis of prospectively collected data of adults age ≥65 years with cancer undergoing chemotherapy. Measures included: the number of daily medications (i.e, polypharmacy); PIM use based on 3 indices [Beers, Zhan, and Drugs to Avoid in the Elderly (DAE) criteria], as well as use of 6 “high-risk” medication classes for adverse drug events (i.e., anticoagulants, antiplatelet agents, opioids, insulin, oral hypoglycemics and antiarrhythmics). Using multivariate logistic regression, the relations were evaluated between these criteria and 1) Grade 3-5 chemotherapy-related toxicity; and 2) hospitalization during chemotherapy. Results The patients (N=500; mean age, 73 years, 61% Stage IV disease) took a mean of 5 daily medications (±4; range, 0-23). PIM use among patients was common (up to 29% using Beers criteria). No association was found between the number of daily medications and either toxicity (0-3 medications as reference: 4-9, OR=1.34, 95% CI: 0.92-1.97; ≥10, OR=0.82, 95% CI: 0.45-1.49), or hospitalization (0-3 medications as reference, ≥4, OR=1.34, 95%CI: 0.82-2.18, p=0.24). There was also no association between PIM use and toxicity (p=0.93) or hospitalization (p=0.98). No medication class was associated with either outcome. Conclusions Polypharmacy and PIM use were common but werenot associated with chemotherapy-related toxicity or hospitalization in older adults with cancer.

Frequency and Determining Factors of Empiric Chemotherapy Dose Reduction in Patients with Non-Small Cell Lung Cancer

“…Previous studies had identified anticoagulants and oral hypoglycemics such as metformin/ glyburide to be 'high risk' medication classes for adverse drug events in the elderly population based on the Beers, Zhang, and Drugs to Avoid in the Elderly criteria [21,22]. However, their results suggested no association between polypharmacy and potentially inappropriate medication use with chemotherapyrelated toxicity or hospitalization in seniors with cancer [21].…”

“…In addition to the quantity of medications, types of medications were also important in evaluating potential adverse drug interaction with chemotherapy [21,22]. Previous studies had identified anticoagulants and oral hypoglycemics such as metformin/ glyburide to be 'high risk' medication classes for adverse drug events in the elderly population based on the Beers, Zhang, and Drugs to Avoid in the Elderly criteria [21,22].…”

A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient

“…The MAI has primarily been studied in older veterans; currently no comprehensive study has used MAI for patients with cancer [13][14][15][16][17]. Despite the lack of data, the MAI could be used and modified for the cancer patient because the 10-item list evaluates relevant aspects of care for a patient with cancer.…”

“…STOPP incorporates 65 criteria that are also organized by physiologic system, with additional focus on analgesics, duplicate drug classes, and drugs that increase fall risk. These screening tools were developed by a consensus panel of 18 experts [8][9][10][11][12][13][14][15][16][17][18].…”

“…Additional studies have applied and discussed the use of START/STOPP in the cancer population while noting limitations and the current lack of evidence [8,[11][12][13][14][15][16][17][18].…”