Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain

Morio, Kayoko; Maeda, Isseki; Yokota, Isao; Niki, Kazuyuki; Murata, Taizo; Matsumura, Yasushi; Uejima, Etsuko

doi:10.1177/1049909118824031

Cited by 10 publications

(5 citation statements)

References 30 publications

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“…We observed that participants with poorer functional status also had higher odds of polypharmacy, and the association was still statistically significant after additionally adjusting for lifestyle factors and comorbidities (OR, 1.72; 95% CI, 1.31–2.26 for poor functional status vs excellent functional status). This finding is in agreement with previous studies, which investigated the associations between patient characteristics and polypharmacy in older patients with cancer and observed that poorer ECOG performance status was significantly associated with polypharmacy [ 35 , 36 ]. Interestingly, in our cohort, age was not associated with polypharmacy any more in the full model, in which we included more clinically relevant variables than age, like the functional status and 13 diseases/conditions.…”

Section: Discussionsupporting

confidence: 93%

Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients

et al. 2021

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Background. In geriatric oncology, polypharmacy is often assessed during a comprehensive geriatric assessment. Previous studies about its association with survival among colorectal cancer (CRC) patients were inconclusive and had high risk for indication bias. Patients and Methods. A cohort study was conducted with 3,239 CRC patients, aged ≥65 years, who were recruited in Germany between 2003 and 2016 while being hospitalized for CRC surgery. We defined polypharmacy as concurrent use of 5 or more drugs, and excessive polypharmacy (EPP) as concurrent use of 8 or more drugs. Cox proportional hazards regression models were performed to assess the associations of polypharmacy with 5-year overall (OS), CRC specific (CSS), and non-cancer specific survival (NCS) with rigorous adjustment for morbidity to minimize indication bias (e.g., for cancer stage, functional status, and 13 common diseases/conditions). Results. The prevalence of polypharmacy was 54.7% and that of EPP was 24.2%. During up to 5 years of follow-up, 1,070 participants died among whom 615 died of CRC and 296 died of other causes than cancer. EPP was statistically significantly associated with poorer up to 5-year OS (hazard ratio (HR) [95% CI]: 1.23 [1.02-1.47]) and CSS (1.31 [1.03-1.68]). HR point estimate for NCS was higher than 1 (1.22) but not statistically significant. Conclusion.Polypharmacy was very common and EPP was a weak risk factor for mortality in this large cohort of older CRC patients. Clinical trials are needed to address the causality of this relationship because older CRC patients might benefit from de-prescribing drugs without an indication. The Oncologist 2021;9999:• • Implications for Practice: The results of our study support the hypothesis that excessive polypharmacy, defined as use of 8 or more concurrently used active substances, has a negative impact on older colorectal cancer (CRC) patients' prognosis.Our study suggests to oncologists that performing a medication review for older CRC patients with 8 drugs or more is indicated (especially when a broader comprehensive geriatric assessment is being performed). Such a medication review should not only focus on reducing the number of medications (by de-prescribing drugs without an indication) but should also check the appropriateness of indicated drugs for older (cancer) patients.

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Section: Discussionsupporting

confidence: 93%

Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…43,44 For instance, multimorbidity could complicate or delay cancer, anxiety, depression, and other diagnoses, limit the possibility to receive optimal treatments, delay their initiation, decrease adherence and persistence, increase the risk of polypharmacy and adverse drug interactions. 16,[43][44][45][46][47][48] Most importantly, a high burden of comorbid conditions leads to decreased survival in cancer. 23,30,44,[48][49][50] As a retrospective observational study, although we were unable to determine the causal relationships between multimorbidity and anxiety and depression, our findings regarding these associations are valuable.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

Dai

Coetzer

Zion³

et al. 2022

Cancer Control

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Background Multimorbidity is common in patients with breast cancer, thus increasing the complexity of cancer care and economic burden, worsening their prognosis and quality of life. The prevalence of multimorbidity and its influence on psychological distress among patients with breast cancer have not been well characterized. Objectives To examine the prevalence of multimorbidity and its associations with anxiety and depression among newly diagnosed patients with breast cancer. Methods We conducted a retrospective observational cohort study using a large administrative claims database. Patients with breast cancer (ICD-10-CM: C50.x) were identified during the study period (1/1/2017-12/31/2020). The index date was defined as the diagnosis date of breast cancer. Demographics and comorbid conditions were assessed using data within 12 months prior to the index date. Multimorbidity was defined as the presence of ≥2 comorbid conditions. Anxiety and depression were examined using data within 12 months after the index date. Multivariable logistic regressions were performed to examine the associations between multimorbidity and anxiety and depression, adjusting for sociodemographic factors. Results Of the 6392 patients with newly diagnosed breast cancer, 86.9% had multimorbidity at the time of breast cancer diagnosis. The median number of comorbid conditions was 5. Overall, 27.7% experienced anxiety, and 21.9% experienced depression in the first year following breast cancer diagnosis. An increased number of comorbid conditions was associated with elevated prevalence of both anxiety and depression. After adjusting for possible confounding factors, number of comorbid conditions was significantly associated with risk of anxiety (adjusted odds ratio [95% confidence interval (CI)]: 1.17 [1.15-1.19]), and depression (1.24 [1.21-1.26]); all P < .0001. Conclusions Multimorbidity was highly prevalent among patients with breast cancer and was strongly associated with increased risk of anxiety and depression in the first year following breast cancer diagnosis. The presence of multimorbidity, anxiety, and depression should be considered in the context of clinical decision making to optimize cancer care and improve mental health and quality of life.

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“…MMB impacts people with cancer directly through an increased physiological burden of disease and/or indirectly through healthcare factors related to treatment decision-making and the increased complexity of care (15). For example, MMB can complicate and delay cancer and other diagnoses, increasing treatment complexity, risk of polypharmacy, and/or other redundancies in care (16)(17)(18)(19)(20). Critically, cancer patients with MMB are less likely to be offered active or curative therapies (21)(22)(23), despite growing evidence that such treatments are tolerated and effective for some patients with cancer MMB (24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Multimorbidity in Adults with Cancer, and Associated Health Service Utilization in Ontario, Canada: A Population-based Retrospective Cohort Study

Koné

Scharf

2021

Preprint

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Background: The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients’ clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. Methods: We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N=601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes including health service utilization and death. Results: MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates.Conclusions: People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These finds can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB due to commonly occurring chronic conditions.

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Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain

Cited by 10 publications

References 30 publications

Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients

Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients

Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

Prevalence of Multimorbidity in Adults with Cancer, and Associated Health Service Utilization in Ontario, Canada: A Population-based Retrospective Cohort Study

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