Rochester, NY—Polypharmacy is extremely common in older adults initiating cancer treatment and puts them at risk for potentially inappropriate medications (PIMs), potential drug-drug interactions (DDIs), and drug-cancer treatment interactions (DCIs).
Even for patients without cancer, multiple-medication use can be risky, according to lead author Erika Ramsdale, MD, a Wilmot Cancer Institute oncologist, geriatrics specialist, and data scientist.
"As doctors, we tell people to take medications but we don't always do a great job of following up," she stated. "From the patient perspective, if it's determined that a medication is no longer needed, it's hard to stop taking it. There's a sense of, 'What will happen if I stop?' or 'Are you giving up on me?' A lot of uncertainty and emotions are tied up in this issue."
Dr. Ramsdale cautioned that the longer the list of drugs and supplements a person takes, the higher the risk of inappropriate use and serious DDIs.
In The Oncologist journal, researchers described patterns of prescription and nonprescription drug use. Their secondary analysis used baseline data from a previous randomized study enrolling patients aged 70 years and older with advanced cancer starting new systemic cancer treatment. The study team categorized PIM using 2019 Beers criteria and Screening Tool of Older Persons' Prescriptions, while evaluating potential DDI/DCI using Lexi-Interact Online.
The results indicated that among 718 patients with a mean age of 77.6 years, polypharmacy (five or more medications), excessive polypharmacy (10 or more medications), and more than one PIM were identified in 61.3%,14.5%, and 67.1%, respectively.
The most prevalent medications were for cardiovascular prevention/conditions (47%), while nonprescription medications accounted for 26% of total medications and 40% of PIMs, according to the researchers.
The authors advised that one-fourth of the patients had at least one potential major DDI not involving cancer treatment, and 5.4% had one or more potential major DCI. They calculated that each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively.
Part of the problem is the fragmented nature of healthcare across specialties, according to Dr. Ramsdale, who explained, "Sometimes, there is no quarterback." That can lead to "prescribing cascades," wherein additional drugs are given to offset the adverse side effects of the original medications, she added.
The nationwide sample patient group had stage III or IV cancer and other common health conditions, and related medication use. Researchers determined that 70% of the patients overall were at risk for DDIs, and 67% were taking at least one drug that was deemed potentially inappropriate.
More than half (61%) of patients were taking five or more medications before starting chemotherapy, and nearly 15% were taking 10 or more medications, according to the report.
Background information in the study pointed out that—among older adults with cancer receiving chemotherapy—polypharmacy is associated with dramatic increases (up to 114%) in unplanned hospitalizations.
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