Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Erika Ramsdale; Mostafa Mohamed; Veronica Yu; Ethan Otto; Katherine Juba; Hala Awad; Kiran Moorthi; Sandy Plumb; Amita Patil; Nicholas Vogelzang; Elie Dib; Supriya Mohile

doi:10.1093/oncolo/oyac053

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment

Oncologist. 2022 Jul 5;27(7):e580-e588. doi: 10.1093/oncolo/oyac053.

Authors

Erika Ramsdale¹, Mostafa Mohamed¹, Veronica Yu¹, Ethan Otto¹, Katherine Juba^{2

3}, Hala Awad⁴, Kiran Moorthi¹, Sandy Plumb¹, Amita Patil⁵, Nicholas Vogelzang⁶, Elie Dib⁷, Supriya Mohile¹

Affiliations

¹ James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
² Department of Pharmacy Practice, Wegmans School of Pharmacy, Rochester, NY, USA.
³ Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, NY, USA.
⁵ School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
⁶ Nevada Cancer Research Foundation, NCI Community Oncology Research Program, Las Vegas, NV, USA.
⁷ St. Joseph Mercy Cancer Center, Ypsilanti, MI, USA.

Abstract

Purpose: Polypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI.

Methods: This secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons' Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI.

Results: Among 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains.

Conclusion: In a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.

Keywords: drug-drug interactions; geriatric oncology; medication use; polypharmacy; potentially inappropriate medications; supportive care.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Aged
Aged, 80 and over
Drug Interactions
Humans
Neoplasms* / drug therapy
Polypharmacy
Potentially Inappropriate Medication List*
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding