The Impact of Polypharmacy on Patient Outcomes in Older Adults With Cancer

Nightingale, Ginah; Skonecki, Emily; Boparai, Manpreet K.

doi:10.1097/00130404-201707000-00004

Cited by 11 publications

(9 citation statements)

References 64 publications

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“…Nevertheless, the rate of excessive polypharmacy was 8.6%, which is similar to that reported in other studies [24,42]. The previously reported prevalence of polypharmacy ranged from 30% to 80% in older patients with solid cancer [7].…”

Section: Discussionsupporting

confidence: 89%

“…This is because such patients are already taking several medications for managing comorbidities and may need additional medications for primary cancer care and supportive care. The prevalence of polypharmacy has been reported to range widely from 29.3% to 80% [7,8], which is related to the increased use of potentially inappropriate medications (PIMs) [9], drug-drug interactions (DDIs) [10][11][12][13], adverse drug events [14], hospitalizations [15], treatment toxicity [16][17][18], and mortality [5,19] in geriatric patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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Background Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. Subjects, Materials, and Methods This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses. Results In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18–2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity. Conclusion Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. Implications for Practice This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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“…Polypharmacy is a particular concern because it is common among older adults and increases the risk for drug-drug interactions, adverse drug events, increased health care cost, and resource utilization. Polypharmacy is typically defined as taking ≥5 medications (including prescription, over-the-counter, and herbal supplements), but no consensus definition exists [4][5][6], and the optimal polypharmacy cutoff point for predicting clinically important adverse events has not been fully substantiated [7]. The risk for drug-drug interactions increases with the number of concurrent drugs: from 13% with the use of two concurrent medications to almost 100% with the use of eight or more medications [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Communication failures often result in medication duplications, unnecessary medications, medication omission/ under-treatment, and prescribing cascades [11]. Preliminary data suggest that polypharmacy in older adults with cancer is associated with negative patient outcomes, including depression, disability, falls, frailty, post-operative complications, mortality, and increased caregiver burden [7,[12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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

Lu‐Yao

Nightingale

Nikita

et al. 2020

Journal of Geriatric Oncology

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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.

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“…In specific subpopulations of patients with cancer, polypharmacy has been associated with worse outcomes [8]. For example, in patients with acute myelogenous leukemia, polypharmacy at diagnosis has been strongly associated with lower odds of complete remission and a higher overall mortality [9].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy in Patients with Ovarian Cancer

et al. 2019

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Objective Polypharmacy has been associated with morbidity and mortality in patients with cancer. Data about polypharmacy among patients with ovarian cancer are limited. The primary objective of this study was to evaluate polypharmacy in a cohort of patients with ovarian cancer and to assess the evolution of polypharmacy from initial presentation to 2 years posttreatment. A secondary objective was to evaluate differences in polypharmacy between a subset of patients primarily treated in our comprehensive cancer center (CCC) and our safety net hospital (SNH). Methods Women treated for ovarian cancer between January 1, 2011, and December 31, 2016, were included. Data were abstracted from the electronic medical record. Medication safety was assessed using the established Anticholinergic Burden (ACB) scale and the Beers criteria. Statistical analyses were performed using paired t tests and Cox proportional hazards models, with significance set at p < .05. Results The study included 152 patients. The majority of patients had high‐grade serous carcinoma. Hypertension was the most common medical problem. The mean number of medications at the time of diagnosis was 3.72. Paired testing demonstrated significant patient‐level increases in the number medications at 2 years following initial diagnosis (4.16 vs. 7.01, p < .001). At the CCC, 47.4% of patients met criteria for polypharmacy at diagnosis compared with 19.4% at the SNH (p < .001). By 2 years postdiagnosis, 77.6% of patients at the CCC met criteria for polypharmacy compared with 43.3% at the SNH (p = .001). The use of any medications on the ACB scale (p < .001) increased significantly between initial diagnosis and 2 years for the entire population. Polypharmacy was not a significant predictor of overall survival. Conclusion Polypharmacy worsens as women go through ovarian cancer treatment. Both at initial presentation and at 2 years postdiagnosis, rates of polypharmacy were higher at the CCC. Polypharmacy did not have an effect on survival in this cohort. Implications for Practice Awareness of escalating numbers of medications and potentially adverse interactions is crucial among women with ovarian cancer, who are at high risk for polypharmacy.

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The Impact of Polypharmacy on Patient Outcomes in Older Adults With Cancer

Cited by 11 publications

References 64 publications

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

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

Polypharmacy in Patients with Ovarian Cancer

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