Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Abstract

Objectives: Polypharmacy (≥5 concurrent medications) is common among older patients with cancer (48%-80%) and associated with increased frailty, morbidity, and mortality. This study examined the relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous (IV) chemotherapy. Materials and Methods: The main data source was the Surveillance, Epidemiology, and End Results-Medicare linked files. Patients (≥65 years) were included if they were diagnosed with prostate (n = 1430), breast (n = 5490), or lung cancer (n = 7309) in 1991-2013 and received IV chemotherapy in 2011-2014. The number of medications during the six-month window pre-IV chemotherapy initiation determined polypharmacy status. Negative binomial models were used to assess the association between polypharmacy and post-chemotherapy inpatient hospitalization. The results were presented as incidence rate ratios. Results: We identified 13,959 patients with prostate, breast, or lung cancer treated with IV chemotherapy. The median number of prescription medications during the six-month window pre-IV chemotherapy initiation was high: ten among patients with prostate cancer, nine among patients with breast cancer, and eleven among patients with lung cancer. Compared to patients taking b5 prescriptions, post-chemotherapy hospitalization rate for patients with prostate cancer was 42%, 75%, and 114% higher among those taking 5-9, 10-14, and 15 + medications, respectively. Patients with breast and lung cancer demonstrated similar patterns. Conclusion: This large population-based study found that polypharmacy during the six-month window pre-IV chemotherapy is highly predictive of post-chemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce post-chemotherapy inpatient hospitalization among older patients with cancer.

Unplanned hospitalizations in older patients with cancer: Occurrence and predictive factors

“…Other reasons also included gastrointestinal, cardiac and pulmonary events (respectively 9%, 8% and 6%). Lu-Yao et al also demonstrated that polypharmacy (>5 medications) was associated with a higher rate of unplanned hospitalizations in patients treated with chemotherapy, although this was not confirmed in our study [23].…”

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

“… 40 In older patients with cancer receiving chemotherapy, polypharmacy is associated with dramatic increases (up to 114%) in unplanned hospitalizations. 41 , 42 In the ELCAPA cohort, potential DDI (but not polypharmacy) was independently associated with the risk of unplanned hospitalization, suggesting that much of the risk may be attributable to DDI and suggesting an opportunity for further study and intervention. In our study, the risk of potential major DDI increased 39% with each additional medication (prescription or nonprescription), and the risk of an interaction with cancer treatment increased 12%, indicating a need to critically evaluate the utility and safety of every medication at the start of cancer treatment.…”

eHealth literacy among older adults living with cancer and their caregivers: A scoping review

“…Cancer is most common among older adults [17,18], who are more vulnerable to comorbid conditions [19] and polypharmacy which further complicates their cancer experience [20,21]. Amongst all people living with cancer, 90% access cancer information online [22], with older adults often citing a preference for their caregivers to acquire online information for them [23,24] to inform their healthcare decisions [25,26].…”