April 15, 2015
Older Adults With Cancer Likely to Take Too Many Drugs

Philadelphia—Polypharmacy (PP), excessive polypharmacy (EPP), and potentially inappropriate medications (PIM) are common in older adults with cancer, according to a new study.

The study from the Jefferson School of Pharmacy at Thomas Jefferson University defined PP as concurrent use of five or more and less than 10 medications, with EPP defined as 10 or more medications. To determine PIM levels, researchers used 2012 Beers Criteria, Screening Tool of Older Person's Prescriptions (STOPP), and the Healthcare Effectiveness Data and Information Set (HEDIS).

The report was published recently in the Journal of Clinical Oncology.

“To our knowledge, this study is the first to combine a clinical pharmacist's expert assessment together with clinically validated, up-to-date criteria and screening tools used by researchers in the field,” said first author Ginah Nightingale, PharmD, BCOP. “There is still a lot we don't know about the impact of excessive and potentially inappropriate medication use for senior adults with cancer, specifically in terms of whether and how increased pill burdens might lead to compromised cancer management plans.”

As part of a multidisciplinary clinic in which older oncology patients are treated by an interprofessional healthcare team including a medical oncologist, geriatrician, clinical pharmacist, social worker, and dietician, the Jefferson researchers looked at drug regimens of 234 seniors.

The study group consisted of 248 patients, average age 79, 64% female, 74% white, and most (87%) with solid tumors. In the 234 patients evaluated by pharmacists and used in the final analysis, 43% were found to be taking more than 10 medications at once, and 51% were taking potentially inappropriate mediations.

“This is a vulnerable population," explained senior author Andrew Chapman, DO. “They are prescribed complicated medical regimens that have a real risk of interfering with their cancer care.”

“It's difficult for an able-bodied adult to keep track of the dosing schedules and appropriate administration of 10 medications, much less for a senior who may have underlying functional or cognitive impairment,” Nightingale added. “This study is meant to give us a baseline, a sense of the landscape, and the risks involved in this population of cancer patients.”

The authors call for comprehensive medication assessments and monitoring plans for all older cancer patients. In addition, Nightingale said the next step for the research team is developing a tool that combines the currently available assessments and considers cancer diagnosis, prognosis, and cancer-related therapy in order to minimize the use of inappropriate medication in the elderly.

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