International Journal of Clinical Pharmacy

, Volume 35, Issue 2, pp 181–184 | Cite as

Patients with advanced lung cancer: is there scope to discontinue inappropriate medication?

  • Adam ToddEmail author
  • Steve Williamson
  • Andy Husband
  • Wasim Baqir
  • Mairead Mahony
Short Research Report


Background Polypharmacy—taking five or medications per day—is common in lung cancer patients. This patient group is prescribed medication to control acute symptoms associated with cancer and also to prevent or treat other long-term conditions. These medications increase the pill burden for the patient and also the probability of developing a drug-related toxicity. Objective To assess the prevalence of inappropriate medication in patients taking erlotinib for the treatment of advanced non-small cell lung cancer. Method This was a multicentre study across three sites in the North of England. Medication histories for patients receiving erlotinib were retrospectively extracted from medical notes and assessed by the clinical team (a consultant pharmacist, nurse specialist and clinical oncologist) to determine if the medication was appropriate or inappropriate. The clinical team considered the following factors when deciding if the medication was appropriate or inappropriate: remaining life expectancy of the patient, time until benefit of the treatment, goals of care and treatment targets. Results Among the 20 patients assessed, 19 (95 %) according to the clinical team were taking medications that were inappropriate. The mean number of medications the patients were taking was 8 (range 1–16) and the most common class of medication used were drugs affecting the Central Nervous System. In addition, there were 11 patients (55 %) who were taking erlotinib in combination with a proton pump inhibitor (PPI)—a clinically significant drug interaction that impairs the absorption of erlotinib. Conclusions Patients taking erlotinib for the treatment of advanced non-small cell lung cancer take many inappropriate medications for the treatment or prevention of long-term conditions. These patients should have their medications reviewed in the context of their original therapeutic goals.


Erlotinib Inappropriate medication Limited life expectancy Lung cancer Medication review Polypharmacy 




Conflicts of interest

None of the authors have any conflicts of interest concerning this work.


  1. 1.
    Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38:666–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Hanlon JT, Schmader KE, Koronkowski MJ, Weinberger M, Landsman PB, Samsa GP, et al. Adverse drug events in high-risk older outpatients. J Am Geriatr Soc. 1997;45:945–8.PubMedGoogle Scholar
  3. 3.
    Lees J, Chan A. Polypharmacy in elderly patients with cancer: clinical implications and management. Lancet Oncol. 2011;12:1249–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Riechelmann RP, Zimmermann C, Chin SN, Wang L, O’Carroll A, Zarinehbaf S, et al. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manag. 2008;35:535–43.CrossRefGoogle Scholar
  5. 5.
    Girre V, Arkoub H, Puts MT, et al. Potential drug interactions in elderly cancer patients. Potential drug interactions in elderly cancer patients. Crit Rev Oncol Hematol. 2011;78:220–6.PubMedCrossRefGoogle Scholar
  6. 6.
    van Erp NP, Gelderblom H, Guchelaar HJ. Clinical pharmacokinetics of tyrosine kinase inhibitors. Cancer Treat Rev. 2009;35:692–706.PubMedCrossRefGoogle Scholar
  7. 7.
    Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166:605–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Fede A, Miranda M, Antonangelo D, Trevizan L, Schaffhausser H, Hamermesz B, et al. Use of unnecessary medications by patients with advanced cancer: cross-sectional survey. Support Care Cancer. 2011;19:1313–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Stavrou EP, Buckley N, Olivier J, Pearson SA. Discontinuation of statin therapy in older people: does a cancer diagnosis make a difference? An observational cohort study using data linkage. BMJ Open. 2012;2:e000880.PubMedCrossRefGoogle Scholar
  10. 10.
    Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012;13:56.PubMedCrossRefGoogle Scholar
  11. 11.
    Tarceva Summary of Product Characteristics. Available at Accessed 21 Nov 2012.
  12. 12.
    Conlon LS, Romero-Ortuno R, Smyth B, Ryan R, Cogan L. General and risk management, patient safety (including: medication errors, quality control): the effect of pharmacist intervention on psychotropic prescribing through clinical medication review in a long-term care hospital in Dublin. Eur J Hosp Pharm. 2012;19:127–8.Google Scholar
  13. 13.
    Gallagher P, Ryan C, Byrne S. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMedGoogle Scholar
  14. 14.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Maddison AR, Fisher J, Johnston G. Preventive medication use among persons with limited life expectancy. Prog Palliat Care. 2011;19:15–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Hilton JF, Seymour J, Le Maitre A, Tu D, Shepherd FA and Bradbury PA. An evaluation of the possible interaction of gastric acid suppressive medication and the EGFR tyrosine kinase inhibitor erlotinib. J Clin Oncol. 2011;29(suppl) (abstr 7523).Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Adam Todd
    • 1
    • 3
    Email author
  • Steve Williamson
    • 2
  • Andy Husband
    • 1
    • 3
  • Wasim Baqir
    • 2
  • Mairead Mahony
    • 1
  1. 1.Department of Pharmacy, Health and Well-being, Faculty of Applied SciencesUniversity of SunderlandSunderlandUK
  2. 2.Pharmacy DepartmentNorthumbria Healthcare NHS Foundation Trust, North Tyneside HospitalTyne and WearUK
  3. 3.Wolfson Research Institute, School of Medicine, Pharmacy and Health, Queen’s CampusDurham UniversityStockton-on-TeesUK

Personalised recommendations