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

Abstract

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.

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

“…In comparison of five DDI programs, including Lexi-Interact, Micromedex, iFacts, Medscape and Epocrates, Lexi-Interact and Micromedex showed the best performance on accuracy and sensitivity ( Kheshti et al, 2016 ). Lexi-Interact was widely used in various diseases and different areas ( Ren et al, 2020 ; Dagdelen et al, 2021 ; Ramsdale et al, 2022 ). Meanwhile, Lexi-Interact was available in our health system, as such, pDDIs were reviewed using Lexi-Interact software in this study.…”

Association of polypharmacy and potential drug‐drug interactions with adverse treatment outcomes in older adults with advanced cancer

“…13 Unlike many prior studies, we included over-the-counter and complementary medications, which are rarely accounted for but are often PIMs and/or are involved in PDIs. 30 In addition, we adjusted for confounding by indication by including patients' comorbidities and functional status as covariates in the multivariable models. In a recent systematic review, we demonstrated that most existing studies evaluated polypharmacy as a covariate or risk factor within a larger exploration of many potential risk factors, which may have created residual confounding issues and spurious associations between medication measures and treatment adverse outcomes.…”

“…A major strength of our study is its understudied population: older adults with advanced cancer receiving treatment in community oncology (i.e., real‐world) practices who are at a high risk of cancer treatment adverse effects 13 . Unlike many prior studies, we included over‐the‐counter and complementary medications, which are rarely accounted for but are often PIMs and/or are involved in PDIs 30 . In addition, we adjusted for confounding by indication by including patients' comorbidities and functional status as covariates in the multivariable models.…”

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

“…For example, embedding the GO-PIM scale in EHRs to automate the detection of PIMs could make targeted "point-of-care" deprescribing feasible in the clinic, which in turn may be associated with a reduction in adverse outcomes. 51 Moreover, leveraging existing databases to identify interactions between PIMs and cancer therapies 63 could improve safety in older adults with blood cancers. eAppendix 1.…”