Prevalence and factors associated with polypharmacy in older people with cancer

Turner, Justin P.; Shakib, Sepehr; Singhal, Nimit; Hogan-Doran, Jonathon; Prowse, Robert; Johns, Sally; Bell, John

doi:10.1007/s00520-014-2171-x

Cited by 130 publications

(129 citation statements)

References 45 publications

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“…The cumulative effect of these factors, as illustrated in Figure 1 and previously described by Shenoy et al (13), can be described as a “snowball effect.” The “snowball,” formed of baseline age-related factors is “set in motion” by the cancer diagnosis and is further exacerbated by cancer treatments which cause direct injury to tissues and organs. Polypharmacy and use of potentially inappropriate medications are prevalent in older adults and can exacerbate the toxicity associated with cancer treatments (14–16). A multidisciplinary approach, including pharmacist involvement, is vital to preventing polypharmacy and inappropriate medication-related toxicities.…”

Section: Risk Factors Of Cardiotoxicitymentioning

confidence: 99%

Cardio-oncology in the older adult

Reddy

Shenoy

Blaes

2017

Journal of Geriatric Oncology

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Heart disease and cancer are the leading causes of death in older adults. Many first-line cancer treatments have the potential for cardiotoxicity. Age-related risk factors, pre-existing cardiac disease, and a high prevalence of comorbidities are reasons for increased cardiotoxicity in older adults. Concerns regarding cardiotoxicity may lead to frailty bias and undertreatment, resulting in suboptimal outcomes. There is an urgent need for geriatric-specific evidence and guidelines to help tailor care for this vulnerable group. A multi-disciplinary approach based on close collaboration between oncologists, cardiologists, and geriatricians, among other specialist clinicians is essential.

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Section: Risk Factors Of Cardiotoxicitymentioning

confidence: 99%

Cardio-oncology in the older adult

Reddy

Shenoy

Blaes

2017

Journal of Geriatric Oncology

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“…Polypharmacy is a problem of growing interest given the increase in drug consumption in recent years, particularly among people over the age of 65. Studies indicate that many older adults with cancer are taking more than five medications [20–24]. Longer life expectancy, co-morbidity and the implementation of evidence-based clinical practice guidelines in the setting of multi-morbidity all contribute to the presence of polypharmacy [25].…”

Section: Introductionmentioning

confidence: 99%

The prognostic importance of polypharmacy in older adults treated for acute myelogenous leukemia (AML)

et al. 2014

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We retrospectively evaluated the prognostic significance of polypharmacy and inappropriate medication use among 150 patients >60 years of age receiving induction chemotherapy for acute myelogenous leukemia (AML). After adjustment for age and comorbidity, increased number of medications at diagnosis (≥4 vs. ≤1) was associated with increased 30-day mortality (OR=9.98, 95% CI=1.18–84.13), lower odds of complete remission status (OR=0.20, 95% CI=0.06–0.65), and higher overall mortality (HR=2.13, 95% CI=1.15–3.92). Inappropriate medication use (classified according to Beers criteria) was not significantly associated with clinical outcomes. Polypharmacy warrants further study as a modifiable marker of vulnerability among older adults with AML.

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“…The START/STOPP criteria are effective at identifying PP targets for intervention [6]. These tools have been applied in the primary care, nursing home, and inpatient settings.…”

Section: Advantagesmentioning

confidence: 99%

“…Additionally, both cancer and its treatments often require multiple supportive care medications, which may increase the risk for adverse effects for the older adult. Polypharmacy (PP) is a term with an evolving definition; its definition has been reviewed extensively elsewhere but is commonly described as five or more medications [2][3][4][5][6][7][8]. One study found that 80% of older patients with a recent diagnosis of cancer took more than five medications [6].…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient

et al. 2016

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Inappropriate medication use and polypharmacy are extremely common among older adults. Numerous studies have discussed the importance of a comprehensive medication assessment in the general geriatric population. However, only a handful of studies have evaluated inappropriate medication use in the geriatric oncology patient. Almost a dozen medication screening tools exist for the older adult. Each available tool has the potential to improve aspects of the care ofolder cancer patients, but no single tool has been developed for this population. We extensively reviewed the literature (MEDLINE, PubMed) to evaluate and summarize the most relevant medication screening tools for older patients with cancer. Findings of this review support the use of several screening tools concurrently for the elderly patient with cancer. A deprescribing tool should be developed and included in a comprehensive geriatric oncology assessment. Finally, prospective studies are needed to evaluate such a tool to determine its feasibility and impact in older patients with cancer. The Oncologist 2016;21:723-730Implications for Practice: The prevalence of polypharmacy increases with advancing age. Older adults are more susceptible to adverse effects of medications. "Prescribing cascades" are common, whereas "deprescribing" remains uncommon; thus, older patients tend to accumulate medications over time. Older patients with cancer are at high risk for adverse drug events, in part because of the complexity and intensity of cancer treatment. Additionally, a cancer diagnosis often alters assessments of life expectancy, clinical status, and competing risk. Screening for polypharmacy and potentially inappropriate medications could reduce the risk for adverse drug events, enhance quality of life, and reduce health care spending for older cancer patients.

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Prevalence and factors associated with polypharmacy in older people with cancer

Abstract: Polypharmacy is highly prevalent in older people with cancer and associated with impaired physical function and being pre-frail and frail compared to being robust. Research is needed to identify strategies to minimize patients' medication regimens.

Cited by 130 publications

References 45 publications

Cardio-oncology in the older adult

Cardio-oncology in the older adult

The prognostic importance of polypharmacy in older adults treated for acute myelogenous leukemia (AML)

A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient

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