Polypharmacy in Patients with Ovarian Cancer

Abstract

Objective Polypharmacy has been associated with morbidity and mortality in patients with cancer. Data about polypharmacy among patients with ovarian cancer are limited. The primary objective of this study was to evaluate polypharmacy in a cohort of patients with ovarian cancer and to assess the evolution of polypharmacy from initial presentation to 2 years posttreatment. A secondary objective was to evaluate differences in polypharmacy between a subset of patients primarily treated in our comprehensive cancer center (CCC) and our safety net hospital (SNH). Methods Women treated for ovarian cancer between January 1, 2011, and December 31, 2016, were included. Data were abstracted from the electronic medical record. Medication safety was assessed using the established Anticholinergic Burden (ACB) scale and the Beers criteria. Statistical analyses were performed using paired t tests and Cox proportional hazards models, with significance set at p < .05. Results The study included 152 patients. The majority of patients had high‐grade serous carcinoma. Hypertension was the most common medical problem. The mean number of medications at the time of diagnosis was 3.72. Paired testing demonstrated significant patient‐level increases in the number medications at 2 years following initial diagnosis (4.16 vs. 7.01, p < .001). At the CCC, 47.4% of patients met criteria for polypharmacy at diagnosis compared with 19.4% at the SNH (p < .001). By 2 years postdiagnosis, 77.6% of patients at the CCC met criteria for polypharmacy compared with 43.3% at the SNH (p = .001). The use of any medications on the ACB scale (p < .001) increased significantly between initial diagnosis and 2 years for the entire population. Polypharmacy was not a significant predictor of overall survival. Conclusion Polypharmacy worsens as women go through ovarian cancer treatment. Both at initial presentation and at 2 years postdiagnosis, rates of polypharmacy were higher at the CCC. Polypharmacy did not have an effect on survival in this cohort. Implications for Practice Awareness of escalating numbers of medications and potentially adverse interactions is crucial among women with ovarian cancer, who are at high risk for polypharmacy.

Gene Signatures and Prognostic Values of N6-Methyladenosine Related Genes in Ovarian Cancer

“…It is the leading cause of gynecologic cancer-related deaths among women, causing 152,000 deaths yearly (Torre et al, 2018). Due to the missing early symptoms and the absence of effective early detection strategies, approximately 70% of OC patients were diagnosis at advanced stage presenting with metastases (Oldak et al, 2019). Although the treatment for OC has been greatly improved in recent decades, the recurrence is frequent and the 5-year overall survival rate remains poor (Coleman et al, 2019).…”

Polypharmacy among Older Advanced Lung Cancer Patients taking EGFR Tyrosine Kinase Inhibitors

“…Studies have included only a small numbers of advanced lung cancer patients and have shown relatively high prevalence (7%-80%) of PP among the patients and its negative impact on clinical outcomes [11,16,[34][35][36][37]. However, the heterogeneity of patients' disease states, baseline characteristics, or treatment modalities across target populations or cancer types might impair the applicability of these results to different clinical situations.…”

“…It is difficult to determine whether older advanced NSCLC patients take more medications compared to other cancer patients. Simple comparisons with previous studies might be inappropriate because of different medication thresholds or time slots (simultaneous [16,17] or continuous [4,41]) used to measure PP. The most commonly used threshold of PP is >=5 concomitant medications, so medications among older advanced cancer patients might indicate the potential utility of other thresholds (excessive polypharmacy [17], major polypharmacy [12]) to detect high-risk patients.…”

“…Both PP and PIM use are attracting attention in the field of oncology with regard to the general geriatric population [11][12][13][14][15]. Studies have shown the prevalence and effect of PP on chemotherapy outcomes, such as survival and adverse events (AEs), in advanced cancer patients [14,[16][17][18]. The mortality in lung cancer, which accounts for˜20% of all cancer deaths, is high compared to other cancers.…”

Accumulation of Good Intentions: How Individual Practice Guidelines Lead to Polypharmacy in the Treatment of Patients with Polytrauma

“…Polypharmacy, defined as using a large number of medications, is often a consequence of treatment for multiple comorbidities and is not specific to PCT. 7 Among adults, persons battling cancer, 8 the elderly, 9 and veterans 10 are the most-reported populations for whom polypharmacy occurs and needs to be addressed. Tinetti et al highlighted that unintended polypharmacy can result from compliance across multiple, noncoordinated clinical practice guidelines (CPGs) for patients with multiple conditions.…”