Skip to main content

Advertisement

Log in

Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting

  • Palliative Medicine (A Jatoi, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This was a single center, retrospective cross-sectional study looking into the incidence and types of drug-related problems (DRPs) detected among elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, and the types of intervention taken to address these DRPs. This paper serves to elucidate the prevalence and risk of polypharmacy in our geriatric oncology population in an ambulatory care setting, to raise awareness on this growing issue and to encourage more resource allocation to address this healthcare phenomenon.

Recent Findings

DRP was detected in 77.6% of elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, with an average incidence of three DRPs per patient. Approximately half of DRPs were related to long-term medications. Forty percent of DRPs required interventions at the prescriber level. The use of five or more medications was shown to almost double the risk of DRP occurrence (OR 1.862, P = 0.039). Out of the eight predefined categories of DRPs, underprescribing was the most common (26.7%), followed by adverse drug reaction (25.0%) and drug non-adherence (16.2%).

Summary

Polypharmacy leading to DRPs is a common occurrence in elderly cancer patients receiving outpatient IV chemotherapy. There should be systematic measures in place to identify patients who are at greater risk of inappropriate polypharmacy and DRPs, and hence more frequent drug therapy optimization and monitoring. The identification of DRPs is an important step to circumvent serious drug-related harm. Future healthcare interventions directed at reducing DRPs should aim to assess the clinical and economic impact of such interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open. 2016;6:e010989. https://doi.org/10.1136/bmjopen-2015-010989.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Duerden M, Avery AJ, Payne RA. Polypharmacy and medicines optimisation: making it safe and sound. London: King’s Fund; 2013.

    Google Scholar 

  3. Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014;70:575–81. https://doi.org/10.1007/s00228-013-1639-9.

    Article  CAS  PubMed  Google Scholar 

  4. Maher Jr RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan;13(1):57–65. https://doi.org/10.1517/14740338.2013.827660.

    Article  Google Scholar 

  5. Singapore Cancer Registry, Annual registry report 2015. Released 19 June 2017.

  6. Balducci L, Goetz-Parten D, Steinman MA; Polypharmacy and the management of the older cancer patient, Annals of Oncology, Volume 24, Issue suppl_7, 1 October 2013, Pages vii36–vii40, doi: https://doi.org/10.1093/annonc/mdt266.

  7. Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.

    CAS  PubMed  Google Scholar 

  9. American Society of Hospital Pharmacists. ASHP statement on pharmaceutical care. Am J Hosp Pharm. 1993:1720–3.

  10. Yeoh TT, Tay XY, Si P, Chew L. Drug-related problems in elderly patients with cancer receiving outpatient chemotherapy. J Geriatr Oncol. 2015;6(4):280–7. https://doi.org/10.1016/j.jgo.2015.05.001.

    Article  PubMed  Google Scholar 

  11. Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging. 2012;29(6):463–75.

    Article  CAS  PubMed  Google Scholar 

  12. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011 March;26(3):155–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sabaté E, editor. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003.

    Google Scholar 

  14. Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014;7:35–44.

    PubMed  PubMed Central  Google Scholar 

  15. Hugtenburg JG, Timmers L, Elders PJ, Vervloet M, van Dijk L. Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Prefer Adherence. 2013;7:675–82.

    Article  PubMed  PubMed Central  Google Scholar 

  16. • Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34(20):2366–71. This study externally validated a chemotherapy toxicity predictive model for older adults with cancer, from eight institutions across the USA. This study fills a gap in the literature by providing evidence of external validation and developing a validated tool to assess chemotherapy toxicity risk among older adults who receive chemotherapy in everyday practice to aid in clinical decision-making.

    Article  PubMed  PubMed Central  Google Scholar 

  17. • Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015;13:74. This is one of the largest population database analysis of community-dispensed prescribing data, comparing all 310,000 adult residents in the Tayside region of Scotland in 1995 and 2010. Receipt of ≥ 10 drugs was strongly associated with increasing age and the number of drugs dispensed was the characteristic most strongly associated with the proportion with potentially serious drug-drug interactions.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf. 2007;30(10):911–8.

    Article  PubMed  Google Scholar 

  19. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.

    Article  CAS  PubMed  Google Scholar 

  20. Yeoh TT, Si P, Chew L. The impact of medication therapy management in older oncology patients. Support Care Cancer. 2013;21(5):1287–93.

    Article  PubMed  Google Scholar 

  21. Dossett LA, Hudson JN, Morris AM, Lee MC, Roetzheim RG, Fetters MD, et al. The primary care provider (PCP)-cancer specialist relationship: a systematic review and mixed-methods meta-synthesis. CA Cancer J Clin. 2017;67(2):156–69. https://doi.org/10.3322/caac.21385.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lita Chew.

Ethics declarations

Conflict of Interest

Ivy Goh, Olive Lai, and Lita Chew declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Palliative Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goh, I., Lai, O. & Chew, L. Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting. Curr Oncol Rep 20, 38 (2018). https://doi.org/10.1007/s11912-018-0686-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-018-0686-x

Keywords

Navigation