Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers

Abstract

Background: Polypharmacy and potentially inappropriate medications (PIMs) are common among older adults with blood cancers, but their association with frailty and how to manage them optimally remain unclear. Patients and Methods: From 2015 to 2019, patients aged ≥75 years presenting for initial oncology consult underwent screening geriatric assessment. Patients were determined to be robust, prefrail, or frail via deficit accumulation and phenotypic approaches. We quantified each patient’s total number of medications and PIMs using the Anticholinergic Risk Scale (ARS) and a scale we generated using the NCCN Medications of Concern called the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. We assessed cross-sectional associations of PIMs with frailty in multivariable regression models adjusting for age, gender, and comorbidity. Results: Of 785 patients assessed, 603 (77%) were taking ≥5 medications and 421 (54%) were taking ≥8 medications; 201 (25%) were taking at least 1 PIM based on the ARS and 343 (44%) at least 1 PIM based on the GO-PIM scale. Among the 468 (60%) patients on active cancer treatment, taking ≥8 medications was associated with frailty (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92–4.17). With each additional medication, the odds of being prefrail or frail increased 8% (aOR, 1.08; 95% CI, 1.04–1.12). With each 1-point increase on the ARS, the odds of being prefrail or frail increased 19% (aOR, 1.19; 95% CI, 1.03–1.39); with each additional PIM based on the GO-PIM scale, the odds increased 65% (aOR, 1.65; 95% CI, 1.34–2.04). Conclusions: Polypharmacy and PIMs are prevalent among older patients with blood cancers; taking ≥8 medications is strongly associated with frailty. These data suggest careful medication reconciliation for this population may be helpful, and deprescribing when possible is high-yield, especially for PIMs on the GO-PIM scale.

Comparison of anticholinergic burden with chronic polypharmacy on functional decline and mortality in Korean older people: a retrospective nationwide cohort study

“…A previous study of 4,402 North Americans showed that taking a greater number of medications was associated with an increased risk of incident frailty compared to taking 0–3 medications (HR [95% CI]; 1.55 [1.22–1.96] for 4–6 medications, 2.47 [1.78–3.43] for ≥ 7 medications) [ 12 ]. Further, a study of 785 patients aged ≥ 75 years with blood cancers reported that the OR for frailty was 2.82 times higher in older people with polypharmacy (≥ 8 medications) compared to in those without polypharmacy (OR 2.82, 95% CI: 1.92–4.17) [ 21 ]. In addition, as the anticholinergic risk score increased by one point, the OR for frailty increased by 19% (OR 1.19, 95% CI: 1.03–1.39) [ 21 ].…”

“…Further, a study of 785 patients aged ≥ 75 years with blood cancers reported that the OR for frailty was 2.82 times higher in older people with polypharmacy (≥ 8 medications) compared to in those without polypharmacy (OR 2.82, 95% CI: 1.92–4.17) [ 21 ]. In addition, as the anticholinergic risk score increased by one point, the OR for frailty increased by 19% (OR 1.19, 95% CI: 1.03–1.39) [ 21 ]. However, unlike this previous finding, our study found that polypharmacy based on taking five medications was not associated with frailty in older people.…”

Feasibility of a comprehensive medication review to improve medication use for patients with cancer and comorbid conditions

“…Given the aforementioned increased use of longterm anticancer treatment and the rates of comorbid conditions in the aging cancer population, the age of our study population (mean = 65 years) and number of medications (mean = 11) is of great importance. Several publications have highlighted the medicationrelated risks and resultant toxicity in older patients with cancer who receive multiple medications [22][23][24]. Notably, a recent study by Dr. Lu-Yao and colleagues demonstrated the relationship between polypharmacy (≥ 5 concurrent medications) and rates of inpatient hospitalization among older adults (> 65 years) treated with chemotherapy.…”

Nails in older adults

“…As there is an increased prevalence of cancer and polypharmacy among older adults, patients undergoing chemotherapy treatment may experience a variety of nail changes [ 27 ]. Muehrcke’s lines are defined as opaque white transverse bands (apparent leukonychia) separated by normal pink colored nail, due to acute toxicity to tissues with high mitotic activity, such as the nail matrix.…”