The prevalence of major drug-drug interactions in older adults with cancer and the role of clinical decision support software

Nightingale, Ginah; Pizzi, Laura T.; Barlow, Ashley; Barlow, Brooke; Jacisin, Timothy; McGuire, Matthew; Swartz, Kristine; Chapman, Andrew E.

doi:10.1016/j.jgo.2018.02.001

Cited by 47 publications

(46 citation statements)

References 29 publications

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“…We regarded major DDIs as those in category D and X out of the five classifications of Lexi-comp Drug Interactions. The prevalence of DDIs in this population also varied compared with the ranges reported previously [10]. Such variation is likely due to differences in the definition of major DDIs, software used for detection, cancer types of the patients, and treatment patterns.…”

Section: Discussionmentioning

confidence: 63%

“…Moreover, drug interactions may be highly prevalent for the geriatric oncology population, and this situation warrants further attention with respect to polypharmacy, especially for patients undergoing chemotherapy. Indeed, patients with newly diagnosed cancer are likely to receive additional medications and chemotherapeutic agents within a narrow therapeutic window, and the major DDIs in these populations have been reported to range from 33% to 69% .…”

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: Discussionmentioning

confidence: 63%

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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“…Elderly patients with cancer are likely to experience polypharmacy (e.g., concurrent use of ≥ 5 prescription/over-thecounter medications and herbal supplements [43]). In addition to receiving cancer therapy and supportive medications to prevent side effects, elderly patients are likely to have comorbidities requiring drug therapy.…”

Section: Polypharmacy and Drug-drug Interactionsmentioning

confidence: 99%

“…Of note, because the metabolism, distribution, and elimination of monoclonal antibodies are not mediated by cytochrome P450 or drug transporters, monoclonal antibody therapies are not expected to compete directly with chemically-derived drugs and, therefore, the risk of DDIs may be lower with such therapies [47,48]. In 13 studies of elderly patients with cancer, DDI prevalences ranging from 2 to 77% were reported [43]. However, it should be noted that the studies differed in trial design, methodology, and, importantly, definitions of DDIs.…”

Section: Polypharmacy and Drug-drug Interactionsmentioning

confidence: 99%

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

2020

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Treatment options for patients with advanced gastric cancer (AGC) are limited. One approach to improving survival in patients with AGC is to optimize the available agents via sequential therapy. However, clinical trial reports of first-line chemotherapy indicate that elderly patients and patients with massive ascites are less likely to receive subsequent lines of therapy. In addition, clinical trials of second-and third-line chemotherapy generally exclude these two patient populations because they are likely to have poor performance status and additional issues that are difficult to manage. Good patient management is likely to be key to the successful use of sequential therapy in these two patient populations by minimizing adverse effects to allow patients to derive benefit from the additional treatment. This narrative review summarizes the available information on AGC treatment and patient management in elderly patients and patients with massive ascites. The available data suggest that elderly patients benefit from chemotherapy; however, monitoring toxicity is essential to avoid chemotherapy-related toxicities. Important aspects of patient management for elderly patients include symptom monitoring, nutritional support, and fall prevention. The available data for patients with massive ascites show limited success for a range of treatment approaches, including systemic chemotherapy. The management of ascites is also challenging, with no clear guidance on the preferred strategies. To address these gaps in knowledge, future clinical trials should incorporate more inclusive eligibility criteria to enroll populations of patients with AGC that are more reflective of the real-world population with respect to age, complications, and overall health status.

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“…A study found that utilizing clinical decision support software in older adults with cancer was beneficial for detecting DDIs however, variability existed with severity reporting. Future studies need to identify the relevant DDIs with clinical implications in order to optimize medication safety in this population [39].…”

Section: Strategies For Reducing and Preventing The Risk Of Drug Intementioning

confidence: 99%

Does Drug-drug Interactions Attain Enough Attention from Health Care Providers?

Nm¹

2018

Pharm Anal Acta

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Every year many patients are affected by adverse drug events that result from the complication of drug therapy. Drug-Drug Interactions (DDIs) are an expected subtype of adverse drug events. Most potential DDIs are preventable, but it remains a significant problem to patients and the health care system. Among the risk factors associated to DDIs include older age, comorbidities, polypharmacy and hospital stay for long time. DDIs are a considerable clinical problem in the hospitalized cardiac patients, cancer patients, hypertensive patients, and patients with immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Best management of DDIs involves the assessment of the interaction; decision to prescribe, dispense, or manage the interacting combination; follow-up monitoring and suitable patient counseling. Different studies were performed to detect and avoid DDIs. Different strategies have been introduced to reduce and prevent the risk of DDIs through the improvement of labeling on metabolic profile for new drugs and serious drug-drug and drug -gene combination, determination the effect of new guideline on product labeling changes for elderly patient and patients with polypharmacy. In clinical practice pharmacist can use good information sources; clinicians can use screening software for the detection and management of DDIs; consumers and patients can use decision support systems for potential DDIs and medication reconciliation should be considered by healthcare professionals to reduce medication error.

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The prevalence of major drug-drug interactions in older adults with cancer and the role of clinical decision support software

Cited by 47 publications

References 29 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

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

Does Drug-drug Interactions Attain Enough Attention from Health Care Providers?

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