Analysis highlights risks of polypharmacy in elderly cancer patients

Results from a secondary analysis of a randomized controlled trial highlight the risks of polypharmacy with respect to prescription and over-the-counter drugs.

Research published in The oncologist highlights the burden of polypharmacy, potentially inappropriate medications (PIMs) and potential drug-drug interactions (DDIs) and cancer drug-treatment interactions (DCIs) in vulnerable elderly patients with cancer.

It should be noted that the study included over-the-counter medications (which are often not considered in most polypharmacy studies) and found that these over-the-counter medications are frequently IMPs and/or implicated in potential DDI/DCI, the authors wrote.

Polypharmacy is defined as the concurrent use of multiple medications and is common in older adults with cancer, the researchers explained, as older adults are more likely to be prescribed “multiple medications due to multimorbidity, frailty and other age-related geriatric syndromes” than their younger counterparts.

The fragmentation of care between several specialties, in addition to prescribing cascades aimed at mitigating the adverse effects of other drugs, also contributes to high rates of polypharmacy in this population.

Polypharmacy and PIMs are associated with mortality, falls, and hospitalizations in older adults, and PIMs may even decrease tolerance to cancer treatments and worsen patient outcomes.

To better understand polypharmacy, PIMs, DDIs, and ICDs in an older population with cancer, researchers assessed data from 718 individuals recruited from a national, prospective, cluster-randomised geriatric assessment (GA) trial, conducted in community oncology practices.

Patients were recruited between July 2014 and March 2019 and completed a polypharmacy diary. All participants were 70 years of age or older, had been diagnosed with incurable stage III or IV solid tumor cancer or lymphoma, and were planning to start a new cancer treatment with a high risk of grade 3 to 3 toxicity. 5. Participants also had to be impaired in at least 1 GA domain outside of polypharmacy.

“Polypharmacy was defined as use of ≥5 regular medications, while excessive polypharmacy was defined as use of ≥10 regular medications,” the authors wrote.

The mean age of the patients was 77.2 years and 43.3% were women; the majority (n=628) were non-Hispanic white and had stage IV cancer (n=628).

The analyzes revealed:

  • Polypharmacy, excessive polypharmacy and at least 1 IMP were identified in 61.3%, 14.5% and 67.1% of patients, respectively.
  • Cardiovascular drugs were the most common (47%) and over-the-counter drugs accounted for 26% of total drugs and 40% of PIDs.
  • A quarter of patients had at least 1 potential major DDI not involving cancer treatment, and 5.4% had at least 1 potential major DDI.
  • Each additional drug increased the risk of a potential major DDI and ICD by 39% and 12%, respectively; each additional prescription drug increased these odds by 40% (P P
  • Patients on polypharmacy were more likely to be older (mean age, 77.5 vs 76.7 years), to have functional impairment (62.1% vs 50.0%), to be physically impaired ( 94.8% vs 90.1%), to have a significant comorbidity (78.0% vs 50.7%), and have an altered psychological state (32.7% vs 21.9%).

Hypertension, arthritis, heart disease and diabetes were the most common non-cancer comorbidities in the cohort, and each patient took an average of 5 medications. Common over-the-counter medications included proton pump inhibitors, nonsteroidal anti-inflammatory drugs, and antihistamines.

“Older adults may mistakenly assume that over-the-counter medications are safe for them, and providers may not be aware of all the medications their elderly patients are taking if a prescription has not been generated” , wrote the authors.

“This study therefore helps to delineate the size and shape of a problem underestimated by providers and patients, and highlights an opportunity for improved medication reconciliation, patient and caregiver education. , deprescribing and other interventions,” they added.

About 10% of hospitalizations in the elderly are associated with adverse drug events, most of which are considered preventable, while in people undergoing chemotherapy, polypharmacy has been associated with an increased risk of unplanned hospitalization that can reach 114%.

The nature of the study, in that it is a secondary analysis of a randomized clinical trial, marks an important limitation.

“Further work is urgently needed to implement and evaluate interventions addressing polypharmacy and IMPs in older people with cancer, especially those starting cancer treatment,” the researchers concluded.

Reference:

Ramsdale E, Mohamed M, Yu V, et al. Polypharmacy, potentially inappropriate drugs, and drug interactions in vulnerable older adults with advanced cancer starting cancer treatment. Oncologist. Published online March 28, 2022. doi:10.1093/oncolo/oyac053


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