Potential Medication-Related Problems in Older Breast, Colon, and Lung Cancer Patients in the United States

Abstract

Older adults are often exposed to multiple medications, some of which could be inappropriate or have the potential to interact with each other. Older cancer patients may be at increased risk for medication-related problems due to exposure to cancer-directed treatment. We described patterns of potentially inappropriate medication (PIM) use and potential drug-chemotherapy interactions among adults age 66+ years diagnosed with stage I-III breast, stage II-III colon, and stage I to II lung cancer. Within the Surveillance, Epidemiology, and End Results-Medicare database, patients had to have Medicare Part D coverage with 1+ prescription in the diagnosis month and Medicare Parts A/B coverage in the prior 12 months. We estimated monthly prevalence of any and cancer-related PIM from 6 months pre- to 23 months postcancer diagnosis and 12-month period prevalence of potential drug-chemotherapy interactions. Overall, 19,318 breast, 7,283 colon, and 7,237 lung cancer patients were evaluated. Monthly PIM prevalence was stable prediagnosis (37%-40%), but increased in the year following a colon or lung cancer diagnosis, and decreased following a breast cancer diagnosis. Changes in PIM prevalence were driven primarily by cancer-related PIM in patients on chemotherapy. Potential drug-chemotherapy interactions were observed in all cohorts, with prevalent interactions involving hydrochlorothiazide, warfarin, and proton-pump inhibitors. There was a high burden of potential medication-related problems among older cancer patients; future research to evaluate outcomes of these exposures is warranted. Older adults diagnosed with cancer have unique medication management needs. Thus, pharmacy specialists should be integrated into multidisciplinary teams caring for these patients. .

Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis

“…The time frame for identification of PIM in patients with cancer may be problematic: many are prescribed supportive care medications considered potentially inappropriate in older adults, although these are usually administered transiently and may be specifically appropriate to treat symptoms related to cancer or cancer treatment. One study has noted a transient elevation in PIM prevalence after a lung or colon cancer diagnosis, which was mostly due to the use of supportive care medications . Most current PIM assessment tools consist of explicit criteria which account for little patient context; assessment of the appropriateness of medications could be improved with tools using implicit criteria, such as the MAI, but such tools require time and expertise for application.…”

Polypharmacy and patterns of prescription medication use among cancer survivors

“…MEPS respondents do not report prescription indication, a limitation common in pharmacoepidemiology research . We could not determine the appropriateness of each medication, but studies regarding older cancer survivors have suggested that potentially inappropriate use is common and increases in the year after diagnosis . We did not capture over‐the‐counter medication or supplement use, potentially underestimating the prevalence of polypharmacy in cancer survivors.…”

“…40 We could not determine the appropriateness of each medication, but studies regarding older cancer survivors have suggested that potentially inappropriate use is common 12,41,42 and increases in the year after diagnosis. 43 We did not capture over-the-counter medication or supplement use, potentially underestimating the prevalence of polypharmacy in cancer survivors. These limitations highlight the need for clinically annotated data, including indication and disease severity, to understand the impact of polypharmacy on cancer outcomes.…”

Polypharmacy in Cancer Patients: Health-Related Quality of Life, Expenditures, and Adverse Events

“…19 For patients who could not remember, or otherwise did not provide a response for age at diagnosis, we used a statistical multiple imputation procedure to assign time since cancer diagnosis. 27 Multiple imputation is an iterative process which uses the distribution of the observed data to estimate the true value of the missing variable. Values produced were used in regression analysis with the results pooled through statistical software to make valid inferences about the parameters and standard errors.…”

“…The categories were curated from published literature based on their relevance to patients with cancer, PP, or both. 22,23 The outcomes selected were based on current literature and have been either (1) well documented in cancer patients, 15,22,23,24,25,26,27,28,29,30,31 and/or (2) were considered more likely in people with PP. 32,33,34,35,36 The goal of choosing these outcomes was to provide a selective list of short-term events which could have been precipitated by the combination of drugs in a population with a lowered immune system, mostly elderly (≥ 65), and who may have been increasing their medications due to anticancer treatment.…”