Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients
- 1k Downloads
Due to more comorbidities, polypharmacy is common in elderly patients and drug interactions are inevitable. It is also challenging to treat an elderly patient with a diagnosis of cancer. Prevalence and clinical impacts of drug interactions and using potentially inappropriate medications (PIMs) have been studied in geriatric patients. However, these are not well defined in oncology practice. The purpose of this study is to define the prevalence of PIMs and severe drug interactions (SDIs) in elderly cancer patients and investigate the factors associated with them.
Patients more than 65 years of age in both inpatient and outpatient clinics were evaluated. Patient, disease characteristics, and medications used were collected by self reports and medical records. Drug interactions were checked with Lexicomp® and PIM was defined with 2012 update of Beers criteria. Severe drug interactions are defined with category D or X DIs. Logistic regression was used to compute odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between SDIs, PIMs, and clinical parameters.
Four hundered and forty-five elderly patients (286 outpatient, 159 inpatient), with a median age of 70 (65–89) were evaluated. SDIs were present in 156 (35.1 %) of patients, 81 (28.3 %), and 75 (47.2 %) for outpatient and inpatients, respectively (p < 0.001). PIMs were present in 117 (26.6 %) of the patients, 40 (14.2 %), and 77(48.4 %) for outpatient and inpatients, respectively (p < 0.001). In multivariate analysis; polypharmacy (≥5 drugs), inpatient status and diagnosis of lung cancer were associated with severe DIs. Polypharmacy, inpatient status, and bad performance score (ECOG 3–4) were associated with PIMs.
Nearly one third of the elderly cancer patients are exposed to severe drug interactions and PIMs. Clinicians dealing with elderly cancer patients should be more cautious when prescribing/ planning drugs to this group of patients. More strategies should be developed in this group of patients to minimize the medications prescribed and prevent severe DIs.
KeywordsSevere drug interaction Potentially inappropriate medication Elderly Beers Criteria Geriatric oncology Polypharmacy
Compliance with ethical standards
Conflict of interest
There is no conflict of interest. The study has not been supported or funded by any organization, group, or society. The report has been written with contributions of all authors, and all of the authors are in agreement with the content of the manuscript.
- 2.Tam-McDevitt J (2008) Polypharmacy, aging, and cancer. Oncology (Williston Park) 22(9):1052–1055 discussion 5, 8, 60Google Scholar
- 10.Maggiore RJ, Dale W, Gross CP, Feng T, Tew WP, Mohile SG, et al. (2014) Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment. J Am Geriatr Soc 62(8):1505–1512CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Drugs & Drug Interaction (2016, January 7) Retrieved from http://www.uptodate.com/home/drugs-drug-interaction
- 13.Misra D, Seo PH, Cohen HJ (2004) Aging and cancer. Clinical advances in hematology & oncology: H&O 2(7):457–465Google Scholar
- 19.Dushenkov A, Kalabalik J, Carbone A, Jungsuwadee P (2016) Drug interactions with aprepitant or fosaprepitant: Review of literature and implications for clinical practice. J Oncol Pharm Pract. doi: 10.1177/1078155216631408
- 20.Ryan C, O’Mahony D, Kennedy J, Weedle P, Barry P, Gallagher P, et al. (2009) Appropriate prescribing in the elderly: an investigation of two screening tools, beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland. J Clin Pharm Ther 34(4):369–376CrossRefPubMedGoogle Scholar
- 22.Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A (2015) Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol 33(13):1453–1459CrossRefPubMedGoogle Scholar