Use of Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer

Abstract

BackgroundAs survivors of childhood cancer age, development of cancer treatment-related chronic health conditions often occur. This study aimed to describe the pattern of chronic prescription medication use and identify factors associated with polypharmacy among survivors of childhood cancer.MethodsThis was a retrospective study conducted at the pediatric oncology long-term follow-up clinic in Hong Kong. Eligible subjects included survivors who were (1) diagnosed with cancer before 18 years old, (2) were at least 3 years post-cancer diagnosis and had completed treatment for at least 30 days, and (3) receiving long-term follow-up care at the study site between 2015 and 2018. Dispensing records of eligible survivors were reviewed to identify medications taken daily for ≥30 days or used on an “as needed” basis for ≥6 months cumulatively within the past 12-month period. Polypharmacy was defined as the concurrent use of ≥5 chronic medications. Multivariable log-binomial modeling was conducted to identify treatment and clinical factors associated with medication use pattern and polypharmacy.ResultsThis study included 625 survivors (mean current age = 17.9 years, standard deviation [SD] = 7.2 years) who were 9.2 [5.2] years post-treatment. Approximately one-third (n = 219, 35.0%) of survivors were prescribed at least one chronic medication. Frequently prescribed medication classes include systemic antihistamines (26.5%), sex hormones (19.2%), and thyroid replacement therapy (16.0%). Overall prevalence of polypharmacy was 5.3% (n = 33). A higher rate of polypharmacy was found in survivors of CNS tumors (13.6%) than in survivors of hematological malignancies (4.3%) and other solid tumors (5.3%) (P = .0051). Higher medication burden was also observed in survivors who had undergone cranial radiation (RR = 6.31; 95% CI = 2.75–14.49) or hematopoietic stem-cell transplantation (HSCT) (RR = 3.53; 95% CI = 1.59–7.83).ConclusionAlthough polypharmacy was observed in a minority of included survivors of childhood cancer, chronic medication use was common. Special attention should be paid to survivors of CNS tumors and survivors who have undergone HSCT or cranial radiation. These individuals should be monitored closely for drug–drug interactions and adverse health outcomes that may result from multiple chronic medications, particularly during hospitalization in an acute care setting.

Suspected Adverse Drug Reactions in Pediatric Cancer Patients in China: An Analysis of Henan Province Spontaneous Reporting System Database

“…The most common definition for polypharmacy in children included the use of two or more medications ( 13 ). However, the use of multiple therapeutic classes of medications is likely warranted in “complex chronic conditions” such as childhood cancer ( 14 ). Thus, our study also adopted the more conservative definition of polypharmacy (five or more medications).…”

Participatory Design of a Medication Module in an Electronic Medical Record for Paediatric Palliative Care: A Think-Aloud Approach with Nurses and Physicians

“…Furthermore, a display fragmentation was identified, particularly in the module for prescribing medications. This fragmentation occurred especially when medication lists were particularly long, which is often the case in PPC [ 15 ]. Display fragmentation is a particular problem in the application of EMRs, as they negatively affect the cognitive load of users.…”

“…However, the electronic medication process used by EMRs in PPC is challenging. There is a high probability of polypharmacy [ 15 ], and the use of off-label or unlicensed medications is common [ 16 ]. Due to the medical complexity and physiological characteristics of patients in PPC, they are particularly vulnerable to medication errors [ 17 ].…”

Improving the experience of obtaining repeat complex paediatric prescriptions in the UK

“…Globally, using primary care records, a scoping review found around 40% of children and young people (CYP) were on more than one medicine 1. Polypharmacy is common in many conditions, for example, nine years after surviving childhood cancer, 5% were on ≥5 chronic medications2; children with medical complexity (CMC) averaged five chronic medications3; in CYP with autism, incidence varies with 7%–87% being on one or more medications4; and CYP with chronic kidney disease (CKD) on >3 medications increase from 42% at stage II to 87% at stage IV CKD 5…”