The influence of polypharmacy on grade III/IV toxicity, prior discontinuation of chemotherapy and overall survival in ovarian cancer

Woopen, Hannah; Richter, Rolf; Ismaéel, Fakher; Chekerov, Radoslav; Roots, Ivar; Siepmann, Timo; Sehouli, Jalid

doi:10.1016/j.ygyno.2016.01.012

Cited by 38 publications

(29 citation statements)

References 14 publications

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“…Patients with existing oral medication intake were more willing to add another tablet to their daily routine, while patients not taking tablets regularly preferred intravenous administration of maintenance therapy. In prior studies, comedication and comorbidity did not influence overall survival or failure of chemotherapy 21. These findings highlight the acceptance and compliance towards maintenance therapy by patients diagnosed with ovarian cancer, with no difference between the primary and relapse setting.…”

Section: Discussionsupporting

confidence: 50%

Expectations and preferences of patients with primary and relapsed ovarian cancer to maintenance therapy: A NOGGO/ENGOT-ov22 and GCIG survey (Expression IV)

Rohr

Alavi

Richter

et al. 2020

Int J Gynecol Cancer

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BackgroundMaintenance therapy induces remission and prolongs disease free interval in primary and recurrent ovarian disease. For the treatment decision making process, aspects of quality of life and patients′ preferences are crucial, despite the fact that scientific data are lacking. Therefore, we conducted this European-wide study in patients with ovarian cancer.MethodsA 25 item questionnaire was provided to ovarian cancer patients via the internet or as a paper version in 10 European countries (Austria, Belgium, France, Germany, Italy, Romania, Slovenia, Finland, Turkey, and Spain). Data recorded were demographics, tumor stage, therapy after firstline and recurrent disease, preferences for administration, and expectations concerning maintenance therapy.ResultsOverall, 1954 patients participated from September 2013 to March 2016; 42% had recurrent disease. Most patients (98%) with primary epithelial ovarian cancer underwent surgery followed by chemotherapy (91%). Almost one-third of participants (29%) were receiving maintenance therapy whereas 45% had only heard of it. For 70% of patients with primary epithelial ovarian cancer, they heard about maintenance therapy from their doctor, 10% heard about maintenance therapy from other patients, and 8% from the internet. The main source of information about maintenance therapy in patients with epithelial ovarian cancer relapse was from the treating physician (72%), from other patients (8%), and from the internet (7%). For patients undergoing maintenance therapy, the four most disturbing adverse effects were polyneuropathy (37%), nausea (36%), hair loss (34%), and vomiting (34%). The main objective of maintenance treatment, as perceived by patients, was to increase the chances of cure (73%), improvement in quality of life (47%), and delay in tumor growth (37%). Many patients were willing to undergo maintenance therapy until tumor progression (38%) and 39% would prefer oral administration. No significant differences were detected in the cross country subanalysis regarding expectations of maintenance therapy and patients with primary or relapsed ovarian cancer.ConclusionPatients with ovarian cancer were willing to accept maintenance therapy of prolonged duration and preferred oral administration. There is still a gap between the efficacy of maintenance therapy and patient expectations. Patients need more information on the adverse effects and treatment goals of maintenance therapy to avoid misunderstandings.

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Section: Discussionsupporting

confidence: 50%

Expectations and preferences of patients with primary and relapsed ovarian cancer to maintenance therapy: A NOGGO/ENGOT-ov22 and GCIG survey (Expression IV)

Rohr

Alavi

Richter

et al. 2020

Int J Gynecol Cancer

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“…Similarly, neither polypharmacy nor PIM use was significantly associated with treatment-related toxicity in older Korean patients with HNC receiving definitive treatment [15], and no association between PIM use and adverse outcomes (ER visits, hospitalization, and death) was observed in older adults with breast and colorectal cancers receiving adjuvant chemotherapy [21]. However, some studies showed associations between polypharmacy and G3-4 chemotherapy-related toxicities in ovarian cancer and breast cancer, respectively [16,17]. We did not find any association between drug measures and treatment G3-4 toxicities (both hematologic and nonhematologic toxicity), although patients with polypharmacy had a 1.73 times higher risk of hospitalization or ER visits.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are several studies that assessed the relationship between polypharmacy and survival, the results are inconsistent. In older patients with ovarian cancer, there was no association of polypharmacy with overall survival [16], and polypharmacy did not influence overall survival in patients receiving palliative radiotherapy [41]. However, in national health insurance senior cohort data, polypharmacy was associated with elevated mortality risk in older adults in Korea [53].…”

Section: Discussionmentioning

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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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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“…Therefore, use of five or more daily medications is not always inappropriate. (18) Individual participant data meta-analysis of data from An increasing number of medications was associated with three phase II/III studies of the North-Eastern German overall grade III/IV toxicity (p<0.001), and hematological Society of Gynecological Oncology, chemotherapy (p<0.001) and non-hematological (p<0.001) toxicities. for recurrent ovarian cancer (N=1213) Unplanned discontinuation of chemotherapy was not influenced by medication.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy in Older Patients ≥70 Years Receiving Palliative Radiotherapy

Nieder

Mannsåker

Pawinski

et al. 2017

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The influence of polypharmacy on grade III/IV toxicity, prior discontinuation of chemotherapy and overall survival in ovarian cancer

Cited by 38 publications

References 14 publications

Expectations and preferences of patients with primary and relapsed ovarian cancer to maintenance therapy: A NOGGO/ENGOT-ov22 and GCIG survey (Expression IV)

Expectations and preferences of patients with primary and relapsed ovarian cancer to maintenance therapy: A NOGGO/ENGOT-ov22 and GCIG survey (Expression IV)

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

Polypharmacy in Older Patients ≥70 Years Receiving Palliative Radiotherapy

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