Drugs & Aging

, Volume 27, Issue 7, pp 559–572 | Cite as

Potential Medication Problems in Older Newly Diagnosed Cancer Patients in Canada during Cancer Treatment

A Prospective Pilot Cohort Study
  • Martine T. E. Puts
  • Johanne Monette
  • Veronique Girre
  • Beatriz Costa-Lima
  • Christina Wolfson
  • Gerald Batist
  • Howard Bergman
Original Research Article



Older cancer patients are possibly at an increased risk of medication-related problems because, typically, they receive many medications during their cancer treatment, both for the cancer itself and for supportive care.


The aim of this study was to describe the number and severity of potential medication problems during treatment of cancer in the first year after diagnosis. We also sought to examine whether patients receiving systemic cancer treatment had more medication-related problems at 3, 6 and 12 months than those not receiving systemic cancer treatment.


This was a prospective pilot cohort study on health and vulnerability in older newly diagnosed cancer patients with 1-year follow-up. The study was conducted at Segal Cancer Centre, Jewish General Hospital, Montreal, Canada. Of 156 eligible patients, 112 agreed to participate (response 71.8%). The patients were aged ≥65 years and were newly diagnosed with breast, colorectal or lung cancer, lymphoma or multiple myeloma. Patients were asked for permission to obtain their list of medications from their pharmacist. The cancer treatment information was abstracted from the medical chart. Vigilance Santé software was used to identify the presence, type and severity of potential medication problems.


The median number of medications was five at baseline, seven at 3 months and six at 6 and 12 months. At baseline, 247 potential medication problems were identified, followed by 273 at 3 months, 229 at 6 months and 188 at 12 months. About half of the patients at each follow-up had one or more moderate or severe potential medication problem. Patients receiving systemic cancer treatment had significantly fewer potential problems at 3 months than patients not receiving systemic cancer treatment, but no differences were observed at 6 and 12 months. The most common warnings were contraindications, interactions and miscellaneous warnings, and the cancer treatment was involved in 12% of all potential problems.


This study showed that the majority of older newly diagnosed cancer patients take prescribed medication and about two-thirds have potential medication problems, of which about half are of at least moderate severity. The cancer treatment was involved in only a small proportion of all potential drug problems.


Community Pharmacist Tamsulosin Candesartan Cilexetil Pamidronic Acid Medication List 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank all of the patients who gave of their time during a very difficult period in their lives to participate in our study. In addition, the authors very much appreciate the support of the staff and volunteers at the Segal Cancer Centre.

This study was supported through a post-PhD research fellowship of the Canadian Cancer Society/National Cancer Institute of Canada to Dr M.T.E. Puts. The study was sponsored by Solidage McGill University/Université de Montreal Research Group on Frailty and Aging, the McGill Dr Joseph Kaufman Chair in Geriatric Medicine and the Oberlander Fund, Division of Geriatric Medicine, Jewish General Hospital. The sponsors played no role in study design, data collection, data analysis, interpretation of data, writing of the report and the decision to submit the paper for publication.

The authors have no conflicts of interest that are directly relevant to the content of this study.

Supplementary material

40266_2012_27070559_MOESM1_ESM.pdf (615 kb)
Supplementary material, approximately 630 KB.


  1. 1.
    Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007; 370: 185–91PubMedCrossRefGoogle Scholar
  2. 2.
    Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007; 370: 173–84PubMedCrossRefGoogle Scholar
  3. 3.
    Lindblad CI, Hanlon JT, Gross CR, et al. Clinically important drug-disease interactions and their prevalence in older adults. Clin Ther 2006; 28: 1133–43PubMedCrossRefGoogle Scholar
  4. 4.
    Hanlon JT, Pieper CF, Hajjar ER, et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006; 61: 511–5PubMedCrossRefGoogle Scholar
  5. 5.
    Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother 2007; 5: 263–303PubMedCrossRefGoogle Scholar
  6. 6.
    Balducci L. Pharmacology of antineoplastic medications in older cancer patients. Oncology (Williston Park) 2009; 23: 78–85Google Scholar
  7. 7.
    Lichtman SM, Boparai MK. Anticancer drug therapy in the older cancer patient: pharmacology and polypharmacy. Curr Treat Options Oncol 2008; 9: 191–203PubMedCrossRefGoogle Scholar
  8. 8.
    Riechelmann RP, Zimmermann C, Chin SN, et al. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage 2008; 35: 535–43PubMedCrossRefGoogle Scholar
  9. 9.
    Riechelmann RP, Tannock IF, Wang L, et al. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst 2007; 99: 592–600PubMedCrossRefGoogle Scholar
  10. 10.
    Riechelmann RP, Moreira F, Smaletz O, et al. Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol 2005; 56: 286–90PubMedCrossRefGoogle Scholar
  11. 11.
    Riechelmann RP, Saad ED. A systematic review on drug interactions in oncology. Cancer Invest 2006; 24: 704–12PubMedCrossRefGoogle Scholar
  12. 12.
    Riechelmann RP, Krzyzanowska MK, O’Carroll A, et al. Symptom and medication profiles among cancer patients attending a palliative care clinic. Support Care Cancer 2007; 15: 1407–12PubMedCrossRefGoogle Scholar
  13. 13.
    Blower P, de Wit R, Goodin S, et al. Drug-drug interactions in oncology: why are they important and can they be minimized? Crit Rev Oncol Hematol 2005; 55: 117–42PubMedCrossRefGoogle Scholar
  14. 14.
    Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management. J Clin Pharm Ther 2007; 32: 169–75PubMedCrossRefGoogle Scholar
  15. 15.
    Riechelmann RP, Del Giglio A. Drug interactions in oncology: how common are they? Ann Oncol 2009; 20: 1907–12PubMedCrossRefGoogle Scholar
  16. 16.
    Buajordet I, Ebbesen J, Erikssen J, et al. Fatal adverse drug events: the paradox of drug treatment. J Intern Med 2001; 250: 327–41PubMedCrossRefGoogle Scholar
  17. 17.
    Riechelmann RP, Krzyzanowska MK, Zimmermann C. Futile medication use in terminally ill cancer patients. Support Care Cancer 2009; 17: 745–8PubMedCrossRefGoogle Scholar
  18. 18.
    Scripture CD, Figg WD. Drug interactions in cancer therapy. Nat Rev Cancer 2006; 6: 546–58PubMedCrossRefGoogle Scholar
  19. 19.
    Flood KL, Carroll MB, Le CV, et al. Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit. Am J Geriatr Pharmacother 2009; 7: 151–8PubMedCrossRefGoogle Scholar
  20. 20.
    Puts MT, Costa-Lima B, Monette J, et al. Medication problems in older, newly diagnosed cancer patients in Canada: how common are they? A prospective pilot study. Drugs Aging 2009; 26: 519–36PubMedCrossRefGoogle Scholar
  21. 21.
    Puts MT, Monette J, Girre V, et al. Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention [letter]. BMC Cancer 2009 Aug 10; 9(1): 277PubMedCrossRefGoogle Scholar
  22. 22.
    Collaborative Staging Task Force of the American Joint Committee on Cancer. Collaborative staging manual and coding instructions, version 01.04.00. 2004; NIH Publication Number 04-5496Google Scholar
  23. 23.
    Carbone PP, Kaplan HS, Musshoff K, et al. Report of the Committee on Hodgkin’s Disease staging classification. Cancer Res 1971; 31: 1860–1PubMedGoogle Scholar
  24. 24.
    Durie BG, Salmon SE. A clinical staging system for multiple myeloma: correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–54PubMedCrossRefGoogle Scholar
  25. 25.
    Groll DL, Heyland DK, Caeser M, et al. Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index. Am J Phys Med Rehabil 2006; 85: 574–81PubMedCrossRefGoogle Scholar
  26. 26.
    Groll DL, To T, Bombardier C, et al. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 2005; 58: 595–602PubMedCrossRefGoogle Scholar
  27. 27.
    Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649–55PubMedCrossRefGoogle Scholar
  28. 28.
    Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009; 27: 2758–65PubMedCrossRefGoogle Scholar
  29. 29.
    Green JL, Hawley JN, Rask KJ. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother 2007; 5: 31–9PubMedCrossRefGoogle Scholar
  30. 30.
    Tamblyn RM, McLeod PJ, Abrahamowicz M, et al. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. CMAJ 1996; 154: 1177–84PubMedGoogle Scholar
  31. 31.
    Miller MF, Bellizzi KM, Sufian M, et al. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc 2008; 108: 483–94PubMedCrossRefGoogle Scholar
  32. 32.
    Sparreboom A, Cox MC, Acharya MR, et al. Herbal remedies in the United States: potential adverse interactions with anticancer agents. J Clin Oncol 2004 Jun 15; 22(12): 2489–503PubMedCrossRefGoogle Scholar
  33. 33.
    Bardia A, Greeno E, Bauer BA. Dietary supplement usage by patients with cancer undergoing chemotherapy: does prognosis or cancer symptoms predict usage? J Support Oncol 2007; 5: 195–8PubMedGoogle Scholar
  34. 34.
    Kumar NB, Allen K, Bell H. Perioperative herbal supplement use in cancer patients: potential implications and recommendations for presurgical screening. Cancer Control 2005; 12: 149–57PubMedGoogle Scholar
  35. 35.
    Lee AH, Ingraham SE, Kopp M, et al. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital. Am J Clin Oncol 2006; 29: 178–82PubMedCrossRefGoogle Scholar
  36. 36.
    Hanigan MH, Dela Cruz BL, Thompson DM, et al. Use of prescription and nonprescription medications and supplements by cancer patients during chemotherapy: questionnaire validation. J Oncol Pharm Pract 2008; 14: 123–30PubMedCrossRefGoogle Scholar
  37. 37.
    Gupta D, Lis CG, Birdsall TC, et al. The use of dietary supplements in a community hospital comprehensive cancer center: implications for conventional cancer care. Support Care Cancer 2005; 13: 912–9PubMedCrossRefGoogle Scholar
  38. 38.
    Markman M. Safety issues in using complementary and alternative medicine. J Clin Oncol 2002; 20: 39S–41SPubMedCrossRefGoogle Scholar
  39. 39.
    Zed PJ, bu-Laban RB, Balen RM, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008; 178: 1563–9PubMedCrossRefGoogle Scholar
  40. 40.
    Oliveria SA, Yood MU, Campbell UB, et al. Treatment and referral patterns for colorectal cancer. Med Care 2004; 42: 901–6PubMedCrossRefGoogle Scholar
  41. 41.
    Siminoff LA, Zhang A, Saunders Sturm CM, et al. Referral of breast cancer patients to medical oncologists after initial surgical management. Med Care 2000; 38: 696–704PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Martine T. E. Puts
    • 1
    • 2
    • 3
  • Johanne Monette
    • 1
    • 4
    • 5
  • Veronique Girre
    • 4
    • 6
  • Beatriz Costa-Lima
    • 1
  • Christina Wolfson
    • 2
    • 7
  • Gerald Batist
    • 5
  • Howard Bergman
    • 1
    • 4
    • 5
  1. 1.Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General HospitalMcGill University/Université de Montreal Solidage Research Group on Frailty and AgingMontrealCanada
  2. 2.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
  3. 3.Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  4. 4.Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General HospitalMcGill UniversityMontrealCanada
  5. 5.Segal Cancer Centre, Jewish General HospitalMcGill UniversityMontrealCanada
  6. 6.Department of Medical OncologyInstitut CurieParisFrance
  7. 7.Division of Clinical EpidemiologyMcGill University Health CentreMontrealCanada

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