Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy

Popa, Mihaela A.; Wallace, Kristie; Brunello, Antonella; Extermann, Martine; Balducci, Lodovico

doi:10.1016/j.jgo.2014.04.002

Cited by 118 publications

(104 citation statements)

References 62 publications

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“…This is because such patients are already taking several medications for managing comorbidities and may need additional medications for primary cancer care and supportive care. The prevalence of polypharmacy has been reported to range widely from 29.3% to 80% , which is related to the increased use of potentially inappropriate medications (PIMs) , drug–drug interactions (DDIs) , adverse drug events , hospitalizations , treatment toxicity , and mortality in geriatric patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, drug interactions may be highly prevalent for the geriatric oncology population, and this situation warrants further attention with respect to polypharmacy, especially for patients undergoing chemotherapy. Indeed, patients with newly diagnosed cancer are likely to receive additional medications and chemotherapeutic agents within a narrow therapeutic window, and the major DDIs in these populations have been reported to range from 33% to 69% .…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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Background Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. Subjects, Materials, and Methods This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses. Results In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18–2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity. Conclusion Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. Implications for Practice This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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“…Another common problem in the elderly is polypharmacy, whether prescribed drugs or over-the-counter medicines and herbs. Drug interactions can double or triple the risk of side effects from the chemotherapy [ 8 ]. Therefore, medications should be reviewed, e.g., using a drug interaction software, and the list pared down according to geriatric principles.…”

Section: Chemotherapy and Targeted Therapiesmentioning

confidence: 99%

Geriatric Oncology

Extermann

Hussain²

2015

Tropical Hemato-Oncology

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Relevance to Tropical AreasAt fi rst glance, geriatric oncology might seem to be a problem limited to developed countries. Yet, as progresses have been made in sanitation, nutrition, and infectious disease prevention and treatment, life expectancy has markedly progressed in tropical countries. For example, the life expectancy at birth is now 65 years or more in 174 of 223 countries listed in the World Factbook, including countries such as India, Bangladesh, the Philippines, Indonesia, Brazil, or Egypt [ 1 ]. In fact in 2000, 59 % of the persons aged 65 and older lived in developing countries, and this proportion is projected to rise to 71 % by 2030 [ 2 ]. With this demographic trend comes an increased prevalence of chronic diseases, cancer being one of them. Therefore, medical teams training and planning for the management of cancer in the elderly will be a crucial component of good cancer care in tropical countries.

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“…The present study is part of the Global Research in Paediatrics Network (GRIP 2007) funded by the Commission under the Seventh Framework Programme (FP7) in order to implement an infrastructure matrix to stimulate and facilitate the development and safe use of medicine in children. GRIP aims to create consensus on international standards, methodologies and tools for paediatric research [1][2]. References: [1] Legrand, F., Boulkedid, R., Elie, V., Leroux, S., Valls, E., Valls-i-Soler, A., Van den Anker, J.N., Jacqz-Aigrain, E., 2014 Introduction: Literature monitoring is a regulatory obligation for a clinical trial (CT) sponsor to follow safety of participants all along.…”

Section: Ps1-003mentioning

confidence: 99%

“…GRIP aims to create consensus on international standards, methodologies and tools for paediatric research [1][2]. References: [1] Legrand, F., Boulkedid, R., Elie, V., Leroux, S., Valls, E., Valls-i-Soler, A., Van den Anker, J.N., Jacqz-Aigrain, E., 2014 Introduction: Literature monitoring is a regulatory obligation for a clinical trial (CT) sponsor to follow safety of participants all along. The objective was to create a standardized literature monitoring of safety information.…”

Section: Ps1-003mentioning

confidence: 99%

A Delphi Process to Optimize Quality and Performance of Drug Evaluation in Neonates

et al. 2014

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BackgroundNeonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently.Methodology and Main FindingsThis Delphi process was conducted with an international multidisciplinary panel of 25 experts from 13 countries, selected to be part of two committees (a scientific committee and an expert committee), in order to validate criteria required to perform drug evaluation in neonates. Eighty six items were initially selected and classified under 7 headings: “NICUs description - Level of care” (21), “Ability to perform drug trials: NICU organization and processes (15), “Research Experience” (12), “Scientific competencies and area of expertise” (8), “Quality Management” (16), “Training and educational capacity” (8) and “Public involvement” (6). Sixty-one items were retained and headings were rearranged after the first round, 34 were selected after the second round. A third round was required to validate 13 additional items. The final set includes 47 items divided under 5 headings.ConclusionA set of 47 relevant criteria will help to NICUs that want to implement, conduct or participate in drug trials within a neonatal network identify important issues to be aware of.Summary Points1) Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. 2) The present Delphi study was conducted with an international multidisciplinary panel of 25 experts from 13 countries and aims to identify the major criteria considered necessary for selecting neonatal intensive care units (NICUs) that are able to perform drug evaluations competently. 3) Of the 86 items initially selected and classified under 7 headings - “NICUs description - Level of care” (21), “Ability to perform drug trials: NICU organization and processes (15), “Research Experience” (12), “Scientific competencies and area of expertise” (8), “Quality Management” (16), “Training and educational capacity” (8) and “Public involvement” (6) - 47 items were selected following a three rounds Delphi process. 4) The present consensus will help NICUs to implement, conduct or participate in drug trials within a neonatal network.

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Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy

Cited by 118 publications

References 62 publications

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Geriatric Oncology

A Delphi Process to Optimize Quality and Performance of Drug Evaluation in Neonates

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