Health professionals' perspectives regarding polypharmacy in older patients with cancer: A mixed-design exploratory study

Sirois, Caroline; Turner, Justin P.; Hébert, Johanne

doi:10.1016/j.jgo.2021.02.027

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Older adults may incorrectly assume that OTC medications are safe for them, and providers may be unaware of the full complement of medications their older patients are taking if a prescription was not generated. This study, therefore, helps delineate the size and shape of a problem underrecognized by both providers and patients, 30 and highlights an opportunity for improved medication reconciliation, patient and caregiver education, deprescribing, and other interventions. 31 …”

Section: Discussionmentioning

confidence: 92%

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Ramsdale

Mohamed

et al. 2022

The Oncologist

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Purpose Polypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI. Methods This secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons’ Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI. Results Among 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains. Conclusion In a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.

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Section: Discussionmentioning

confidence: 92%

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Ramsdale

Mohamed

et al. 2022

The Oncologist

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“…Previous studies investigating the Japanese population showed that polypharmacy was an independent prognostic factor in older patients with advanced NSCLC treated with ICI or epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) [ 28 , 29 ]. With increasing medication complexity in cancer patients, it is necessary to identify issues associated with polypharmacy for patients with cancer [ 31 ]. Considering the negative effect of PIM use on the prognosis of NSCLC patients, we suggest that deprescribing shall be incorporated into routine clinical practices and that medication reconciliation could be a viable strategy to reduce the incidence of PIM use among older adults with NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Association of potentially inappropriate medications with prognosis among older patients with non-small cell lung cancer

Ma,

Xu,

et al. 2024

BMC Geriatr

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Background Potentially inappropriate medications (PIMs) are common among older adults with cancer, but their association with overall survival (OS) among non-small cell lung cancer (NSCLC) patients remains unclear. This study aimed to investigate the association between the use of PIMs and OS in patients with NSCLC. Methods In this cohort study, we included patients ≥ 65 years with newly diagnosed NSCLC from January 2014 to December 2020. Potentially inappropriate medication (PIM) is defined by the Beers criteria of 2019 at baseline and within six months following the initiation of systemic therapy. Multivariable Cox regression model was built to assess the association between PIMs and overall survival (OS). Results We finally included 338 patients with a median follow-up for OS of 1777 days. The prevalence of patients receiving at least one PIM was 39.9% (135/338) and 61.2% (71/116) at baseline and after systemic therapy, respectively. The most important factor associated with PIM use was the number of prescribed medications (P < 0.001). Baseline PIM use and PIM after systemic therapy were significantly associated with inferior OS (476 days vs. 844 days, P = 0.044; and 633 days vs. 1600 days, P = 0.007; respectively). In multivariable analysis, both baseline PIM use and PIM after systemic therapy were independent predictors of poor prognosis (adjusted HR, 1.33; 95% CI, 1.01–1.75; P = 0.041; and adjusted HR, 1.86; 95% CI, 1.11–3.14; P = 0.020; respectively). Conclusions PIMs are prevalent among older patients with NSCLC and are independent predictors of NSCLC prognosis. There is an urgent need for clinicians to conduct medication reconciliation and appropriate deprescribing for this population, especially for patients with multiple PIMs.

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“…Deprescribing studies in older adults with cancer are limited but provide some data showing the feasibility of pharmacist intervention, high patient acceptance of deprescribing, and potential cost savings. Studies evaluating barriers to deprescribing in older adults with cancer are needed 28,29▪.…”

Section: Oncology Pharmacist Roles In Older Adult Cancer Carementioning

confidence: 99%

The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes

Whitman

Fitch

Nightingale

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewProper medication management is an essential part of older adult cancer care. An aging population, an increase in anticancer treatment options, and high rates of comorbid conditions make navigating general medication reconciliation complicated. This review will highlight the recent literature describing the roles of the oncology pharmacist in caring for older adults with cancer. Recent findingsThe body of literature highlighting oncology pharmacist roles in this population is mainly focused on polypharmacy and potentially inappropriate medication assessments, deprescribing nonessential therapies, drug-drug interaction reviews, and immunization optimization. Outcomes associated with oncology pharmacist interventions are still lacking as well as the development of benchmarks for appropriate pharmacybased care in the older adult oncology population. SummaryOncology pharmacist interventions in older adults with cancer have the potential to improve patient care. Future randomized studies in this area of practice are warranted in order to clearly define the optimal impact of oncology pharmacists.

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Health professionals' perspectives regarding polypharmacy in older patients with cancer: A mixed-design exploratory study

Cited by 5 publications

References 22 publications

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Association of potentially inappropriate medications with prognosis among older patients with non-small cell lung cancer

The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes

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