Skip to main content

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

International Journal of Clinical Pharmacy volume 35, pages 181–184 (2013)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  3. Lees J, Chan A. Polypharmacy in elderly patients with cancer: clinical implications and management. Lancet Oncol. 2011;12:1249–57.

    PubMed  Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  6. van Erp NP, Gelderblom H, Guchelaar HJ. Clinical pharmacokinetics of tyrosine kinase inhibitors. Cancer Treat Rev. 2009;35:692–706.

    PubMed  Article  Google Scholar 

  7. Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166:605–9.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  11. Tarceva Summary of Product Characteristics. Available at http://www.medicines.org.uk/EMC/medicine/16781/SPC/Tarceva+25mg%2c+100mg+and+150mg+Film-Coated+Tablets/. Accessed 21 Nov 2012.

  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. 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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  15. Maddison AR, Fisher J, Johnston G. Preventive medication use among persons with limited life expectancy. Prog Palliat Care. 2011;19:15–21.

    PubMed  Article  Google Scholar 

  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).

Download references

Funding

None.

Conflicts of interest

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

Author information

Author notes

  1. Adam Todd & Andy Husband

    Present address: Wolfson Research Institute, School of Medicine, Pharmacy and Health, Queen’s Campus, Durham University, Stockton-on-Tees, TS17 6BH, UK

Affiliations

  1. Department of Pharmacy, Health and Well-being, Faculty of Applied Sciences, University of Sunderland, Wharncliffe Street, Sunderland, SR1 3SD, UK

    Adam Todd, Andy Husband & Mairead Mahony

  2. Pharmacy Department, Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK

    Steve Williamson & Wasim Baqir

Authors
  1. Adam Todd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steve Williamson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andy Husband
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wasim Baqir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mairead Mahony
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam Todd.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Todd, A., Williamson, S., Husband, A. et al. Patients with advanced lung cancer: is there scope to discontinue inappropriate medication?. Int J Clin Pharm 35, 181–184 (2013). https://doi.org/10.1007/s11096-012-9731-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-012-9731-2

Keywords

  • Erlotinib
  • Inappropriate medication
  • Limited life expectancy
  • Lung cancer
  • Medication review
  • Polypharmacy