Patient characteristics associated with polypharmacy and inappropriate prescribing of medications among older adults with cancer
Introduction
In the aging population, polypharmacy and potentially inappropriate prescribing of medication (PIM) is highly prevalent.[1], [2], [3], [4], [5], [6], [7], [8] Polypharmacy has been associated with an increased risk of PIM[1], [5], [6], [9], [10] and increased risk of adverse drug events (ADEs), and may increase the risk of falls and geriatric syndromes as well as morbidity and mortality in the elderly population.[6], [11], [12], [13]
Oncology patients are often on complex medication regimens, and receive medications not only to treat their malignancy and comorbidities, but also to treat therapy-induced toxicity and conditions related to their malignancy such as deep vein thrombosis and seizures.[5], [14], [15], [16] Oncology patients are also seen by multiple physicians, including an oncologist and a primary care physician, who could prescribe multiple different medications for the same symptoms.[5], [17] Compounding the issue of polypharmacy in oncology patients is the use of herbal medications, as prior data has shown that at least one-third of cancer patients use at least one alternative medication.[16], [18] As such, polypharmacy may be more prevalent in older cancer patients. These medications can interact with the patient's regular medication regimen as well as traditional cancer therapies, causing ADEs.[16], [17], [18] Finally, the risk of drug interactions increases with the addition of each antineoplastic agent, placing the patient at risk for further ADEs.[17], [19]
The Beers Criteria were developed from expert consensus to identify potentially inappropriate medications in the elderly population that should be avoided.[2], [3], [4], [20] These criteria include drugs with a long half-life, medications with side effects such as sedation or anticholinergic effects, medications that are high risk when safer alternatives exist or are ineffective, doses of drugs that should not be exceeded, and drug–disease and drug–drug interactions that should be avoided in the elderly populations.[1], [2], [3], [4] The prevalence of PIM use ranges from 33% to 37% of acutely ill patients presenting to hospitals, 28% of elderly community-dwelling residents, 49% of elderly patients presenting to the outpatient primary care clinic and in up to 40% of nursing home residents.[1], [2], [8], [21], [22], [23], [24] Use of Beers Criteria Medications among older patients is associated with increased rate of outpatient visits, reduced time to hospitalization, increased frequency of emergency department visits, increased healthcare costs, and increased mortality.[5], [7], [9], [21] Use of PIMs has been shown to be associated with polypharmacy and with ADEs.[25], [26]
However, few original studies have examined the presence of polypharmacy and inappropriate prescribing of medications in older cancer patients.[14], [15], [27] The objective of this study, therefore, was to examine the prevalence of polypharmacy and the inappropriate prescribing of medications, and to determine factors independently associated with polypharmacy and PIM use among older patients with newly diagnosed cancer.
Section snippets
Study Design and Patient Population
This is a baseline cross-sectional study nested within a longitudinal study of older cancer patients ≥ 65 years of age with histologically confirmed new cancer diagnosis, irrespective of stage at diagnosis. Participants were recruited from ambulatory oncology clinics at an academic center between February 1, 2008 and September 30, 2009. Participants who had received any prior chemotherapy or radiation therapy for current cancer, were unable to give informed consent or were non-English speaking
Participants' Baseline Characteristics
117 patients were enrolled into this study with a mean age of 74.6 years (SD = 6.9). Table 2 displays the distribution of baseline characteristics. The majority of the participants (56%) were between the ages of 65 and 74 years. The study population consisted predominantly of white Medicare-insured patients, about half of whom had more than a high school education (45%), were other than married (65%), and lived alone (42%). Most participants had breast cancer (59%), stage I–II disease (59%), and
Discussion
In this cohort of patients, 65 years and older, with newly diagnosed cancer we found a very high prevalence of polypharmacy, and sometimes, medications being used were inappropriate. Participants with multiple comorbidities, sub-optimal performance status and on inappropriate medications were most likely to be on five or more concurrent medications. Factors associated with inappropriate medication use included having multiple comorbidities and being underweight.
The average use of 7.3 medications
Disclosures
Sponsor's role: The sponsors did not play any role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author Contributions
Conception design: Cynthia Owusu.
Acquisition of data: Cynthia Owusu, Gopi Prithviraj, Rakesh Bagai.
Analysis and interpretation of data: Cynthia Owusu, Gopi Prithviraj, Siran Koroukian, Seunghee Margevicius, Rakesh Bagai, Nathan Berger.
Manuscript writing and approval: Cynthia Owusu, Gopi Prithviraj, Siran Koroukian, Seunghee Margevicius, Rakesh Bagai, Nathan Berger.
Conflict of Interest Statement
The authors have no conflicts of interest to disclose.
Acknowledgments
Funding sources: This study was supported in part by the Cancer Aging Research Program Development Grant (P20 CA103767, Nathan Berger, M.D., Principal Investigator: Cynthia Owusu, M.D., Pilot Project Recipient) and by the Clinical Oncology Research Career Development from the National Cancer Institute (2K12 CA076917-11, Stanton Gerson, M.D., Principal Investigator: Cynthia Owusu, M.D., Paul Calabresi Scholar).
Abstract presentation: Prithviraj G. K., Bagai R, Koroukian S, Berger N, Owusu C:
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