Prevalence and effects of polypharmacy on overall survival in acute myeloid leukemia

Dhakal, Prajwal; Lyden, Elizabeth; Muir, Kate Lynn E.; Al-Kadhimi, Zaid; Koll, Thuy T.; Maness, Lori J.; Gundabolu, Krishna; Bhatt, Vijaya Raj

doi:10.1080/10428194.2020.1737687

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…This becomes apparent when comparing our findings to prior studies in older adults with solid and liquid tumors. [41][42][43][44][45][46][47][48][49] In our cohort, polypharmacy defined as $8 medications was associated with frailty, reinforcing the finding by Mohamed et al 11 that $8 medications best detected functional impairment in older adults with advanced solid tumors. Outlaw et al 41 found that for older patients with gastrointestinal malignancies (n5397), polypharmacy defined as $9 medications was associated with frailty and lower mental health-related quality of life.…”

Section: Discussionsupporting

confidence: 88%

“…Prior studies examining polypharmacy and PIMs in older patients with hematologic malignancies found mixed results, but the sample sizes were smaller, ranging from 80 patients with multiple myeloma (polypharmacy defined as $5 drugs in 64%) to 399 with acute leukemia (polypharmacy defined as $5 medications associated with worse overall survival in patients aged ,60 years but not in those aged $60 years). [44][45][46][47][48] Most also did not control for comorbidity, 9 which raises the potential for confounding by indication: the risk ascribed to high number or inappropriate medications could be driven by underlying comorbidities for which the medications were prescribed. 51 Finally, our cohort of patients is older (age $75 years) than most previously studied cohorts, which may explain some differences in results.…”

Section: Discussionmentioning

confidence: 99%

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Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Hshieh

DuMontier

Jaung

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Polypharmacy and potentially inappropriate medications (PIMs) are common among older adults with blood cancers, but their association with frailty and how to manage them optimally remain unclear. Patients and Methods: From 2015 to 2019, patients aged ≥75 years presenting for initial oncology consult underwent screening geriatric assessment. Patients were determined to be robust, prefrail, or frail via deficit accumulation and phenotypic approaches. We quantified each patient’s total number of medications and PIMs using the Anticholinergic Risk Scale (ARS) and a scale we generated using the NCCN Medications of Concern called the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. We assessed cross-sectional associations of PIMs with frailty in multivariable regression models adjusting for age, gender, and comorbidity. Results: Of 785 patients assessed, 603 (77%) were taking ≥5 medications and 421 (54%) were taking ≥8 medications; 201 (25%) were taking at least 1 PIM based on the ARS and 343 (44%) at least 1 PIM based on the GO-PIM scale. Among the 468 (60%) patients on active cancer treatment, taking ≥8 medications was associated with frailty (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92–4.17). With each additional medication, the odds of being prefrail or frail increased 8% (aOR, 1.08; 95% CI, 1.04–1.12). With each 1-point increase on the ARS, the odds of being prefrail or frail increased 19% (aOR, 1.19; 95% CI, 1.03–1.39); with each additional PIM based on the GO-PIM scale, the odds increased 65% (aOR, 1.65; 95% CI, 1.34–2.04). Conclusions: Polypharmacy and PIMs are prevalent among older patients with blood cancers; taking ≥8 medications is strongly associated with frailty. These data suggest careful medication reconciliation for this population may be helpful, and deprescribing when possible is high-yield, especially for PIMs on the GO-PIM scale.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Hshieh

DuMontier

Jaung

et al. 2022

Journal of the National Comprehensive Cancer Network

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“…Polypharmacy or potentially inappropriate co-medication in people with acute myeloid leukaemia and multiple myeloma has been associated with adverse outcomes, including mortality and falls, in some studies. 25,26 Other studies were unable…”

Section: Comorbidity Scoresmentioning

confidence: 99%

Frailty assessment in the care of older people with haematological malignancies

Goede

Neuendorff

Schulz

et al. 2021

The Lancet Healthy Longevity

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“…In the elderly population of AML patients, the prevalence of polypharmacy is about 80% and a fifth of these patients take at least one inappropriately prescribed medication 33 . The prognostic value of polypharmacy among older patients with AML was investigated only in a few studies 33,46 . Elliot et al proved an association between polypharmacy and an increased incidence of ED and a shorter OS among older adults receiving induction chemotherapy 33 .…”

Section: Geriatric Assessment and Why A Complex Approach Is Neededmentioning

confidence: 99%

“…Elliot et al proved an association between polypharmacy and an increased incidence of ED and a shorter OS among older adults receiving induction chemotherapy 33 . According to the study by Dhakal et al, which was done on a twice bigger sample of AML patients, it was shown that there is no negative impact of polypharmacy on the OS in the elderly AML; however, the Elliot's study was based only on patients treated with a curative intent meanwhile the study by Dhakal et al evaluated the group of patients regardless of the type of treatment 33,46 . Until today, polypharmacy has not been taken into account with regards to patient evaluation very often; on that note, the conclusions of the abovementioned studies raise a question if this should not be revisited.…”

Section: Geriatric Assessment and Why A Complex Approach Is Neededmentioning

confidence: 99%

How to select older patients with acute myeloid leukemia fit for intensive treatment?

Šustková

Semerád

Weinbergerová

et al. 2020

Hematological Oncology

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Outcomes of the treatment of older patients with acute myeloid leukemia (AML) are unsatisfactory due to a higher incidence of negative patient‐ and disease‐related risk factors connected with aging. Prediction of poor tolerance to aggressive treatment and low response to standard intensive chemotherapy are the main root causes why the treatment decision is challenging. For a long time, negative prognostic factors for treatment outcomes, overall survival, and early death such as the age itself, low‐performance status, high‐comorbidity burden, adverse cytogenetics, and secondary AML have been known, and they are routinely taken into account during therapeutic balance. In consideration of the risk factors and specific laboratory results, prognostic models have been created. Despite the abovementioned facts, the survival of older patients with AML remains very poor, that holds true even for the intensive therapy. For that reason, there is an increased effort to find a better approach how to select patients who would benefit from intensive treatment without decreasing their quality of life through severe complications with risk of high treatment‐related mortality. Based on the results of clinical studies, the geriatric assessment could be the missing step which would help select older patients who are really fit for intensive treatment and who will benefit from it the most. This review focuses on the risk factors that should be taken under advisement when the decision about the treatment is made. With reference to the published information, we propose an algorithm how to identify fit, vulnerable, and frail patients.

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Prevalence and effects of polypharmacy on overall survival in acute myeloid leukemia

Cited by 11 publications

References 38 publications

Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Frailty assessment in the care of older people with haematological malignancies

How to select older patients with acute myeloid leukemia fit for intensive treatment?

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