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Drugs & Aging

, Volume 26, Issue 6, pp 519–536 | Cite as

Medication Problems in Older, Newly Diagnosed Cancer Patients in Canada: How Common are They?

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

Abstract

Background

Prescribing for older patients is challenging and complex. Cancer patients are at a considerable increased risk of drug-related problems because they typically receive a large number of medications during their cancer treatment, both for the cancer itself and for supportive care. Few studies have examined the scope of this problem in older newly diagnosed cancer patients.

Objective

To investigate the number and severity of potential drug problems and factors associated with the occurrence of potential drug problems in older newly diagnosed cancer patients.

Methods

This prospective pilot study was conducted in newly diagnosed cancer patients aged ≥65 years recruited in the Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada. Vigilance Santé software was used to identify the presence and type of potential drug problems. Logistic regression analyses were used to identify factors associated with the presence of one or more severe or moderately severe potential drug problems.

Results

There were 112 participants with a mean age of 74.2 years, and 70% were women. A total of 103 patients (92%) were taking medications. The median number of medications per patient was 5 (interquartile range 3–9) and a total of 247 potential drug problems were identified. Sixty-four patients (62.1%) had a potential drug problem of any level of severity and 49 patients had a potential moderate/severe drug problem identified (47.6%). Two (0.8%) potential drug problems of the most severe level were identified, 122 warnings (49.4%) of all potential problems were of moderate severity and 123 warnings (49.8%) were at the least severe level. Factors associated with having one or more moderate/severe potential drug problems were taking five or more drugs and age ≥76 years.

Conclusion

The majority of older newly diagnosed cancer patients in this study were taking at least one medication and the median number of medications per patient was 5. Published studies have shown that medication problems are common in community-dwelling older persons, but they are mostly of low severity. In this group of older newly diagnosed cancer patients, potential medication problems were also found to be common; however, half of the potential problems identified were of moderate severity.

Keywords

Gait Speed Adverse Drug Event Community Pharmacist Inappropriate Medication Potential Drug Interaction 
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.

Notes

Acknowledgement

The work of Dr M. Puts was funded by a postdoctoral fellowship from the Canadian Cancer Society through an award of the National Cancer Institute of Canada. No other sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study. The authors thank all patients who have participated in this study as well as the staff and volunteers of the Segal Cancer Centre for their support. The study was supported by Dr Joseph Kaufmann, Chair in Geriatric Medicine, McGill University, and the Oberlander Fund, Division of Geriatric Medicine, Jewish General Hospital.

Supplementary material

40266_2012_26060519_MOESM1_ESM.pdf (94 kb)
Supplementary material, approximately 96 KB.

References

  1. 1.
    Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007; 370(9582): 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(9582): 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(8): 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(5): 511–5PubMedCrossRefGoogle Scholar
  5. 5.
    Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother 2007; 5(3): 263–303PubMedCrossRefGoogle Scholar
  6. 6.
    Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007; 63(2): 187–95PubMedCrossRefGoogle Scholar
  7. 7.
    Fick DM, Mion LC, Beers MH, et al. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health 2008; 31(1): 42–51PubMedCrossRefGoogle Scholar
  8. 8.
    Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006; 54(10): 1516–23PubMedCrossRefGoogle Scholar
  9. 9.
    Page RL, Ruscin JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother 2006; 4(4): 297–305PubMedCrossRefGoogle Scholar
  10. 10.
    Jano E, Aparasu RR. Healthcare outcomes associated with Beers’ criteria: a systematic review. Ann Pharmacother 2007; 41(3): 438–47PubMedCrossRefGoogle Scholar
  11. 11.
    Pugh MJ, Hanlon JT, Zeber JE, et al. Assessing potentially inappropriate prescribing in the elderly Veterans Affairs population using the HEDIS 2006 quality measure. J Manag Care Pharm 2006; 12(7): 537–45PubMedGoogle Scholar
  12. 12.
    Tulner LR, Frankfort SV, Gijsen GJ, et al. Drug-drug interactions in a geriatric outpatient cohort: prevalence and relevance. Drugs Aging 2008; 25(4): 343–55PubMedCrossRefGoogle Scholar
  13. 13.
    Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289(9): 1107–16PubMedCrossRefGoogle Scholar
  14. 14.
    Fu AZ, Jiang JZ, Reeves JH, et al. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care 2007; 45(5): 472–6PubMedCrossRefGoogle Scholar
  15. 15.
    Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004; 116(6): 394–401PubMedCrossRefGoogle Scholar
  16. 16.
    Pugh MJ, Rosen AK, Montez-Rath M, et al. Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level. Med Care 2008; 46(2): 167–73PubMedCrossRefGoogle Scholar
  17. 17.
    Canadian cancer statistics 2008. Toronto (ON): Canadian Cancer Society/National Cancer Institute of Canada, 2008Google Scholar
  18. 18.
    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(2): 117–42PubMedCrossRefGoogle Scholar
  19. 19.
    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(2): 169–75PubMedCrossRefGoogle Scholar
  20. 20.
    Riechelmann RP, Moreira F, Smaletz O, et al. Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol 2005; 56(3): 286–90PubMedCrossRefGoogle Scholar
  21. 21.
    Riechelmann RP, Saad ED. A systematic review on drug interactions in oncology. Cancer Invest 2006; 24(7): 704–12PubMedCrossRefGoogle Scholar
  22. 22.
    Riechelmann RP, Tannock IF, Wang L, et al. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst 2007; 99(8): 592–600PubMedCrossRefGoogle Scholar
  23. 23.
    Riechelmann RP. Drug combinations with the potential to interact among cancer patients. Support Care Cancer 2007; 15(9): 1113–4PubMedCrossRefGoogle Scholar
  24. 24.
    Riechelmann RP, Zimmermann C, Chin SN, et al. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage 2008; 35(5): 535–43PubMedCrossRefGoogle Scholar
  25. 25.
    Tam-McDevitt J. Polypharmacy, aging, and cancer. Oncology (Williston Park) 2008; 22(9): 1052–5Google Scholar
  26. 26.
    Bierman AS, Pugh MJ, Dhalla I, et al. Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother 2007; 5(2): 147–61PubMedCrossRefGoogle Scholar
  27. 27.
    Murray MD, Morrow DG, Weiner M, et al. A conceptual framework to study medication adherence in older adults. Am J Geriatr Pharmacother 2004; 2(1): 36–43PubMedCrossRefGoogle Scholar
  28. 28.
    Roth MT, Ivey JL. Self-reported medication use in community-residing older adults: a pilot study. Am J Geriatr Pharmacother 2005; 3(3): 196–204PubMedCrossRefGoogle Scholar
  29. 29.
    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(6): 595–602PubMedCrossRefGoogle Scholar
  30. 30.
    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(7): 574–81PubMedCrossRefGoogle Scholar
  31. 31.
    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146–56PubMedCrossRefGoogle Scholar
  32. 32.
    Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85(5): 365–76PubMedCrossRefGoogle Scholar
  33. 33.
    Perera S, Mody SH, Woodman RC, et al. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006; 54(5): 743–9PubMedCrossRefGoogle Scholar
  34. 34.
    Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49(2): M85–94PubMedCrossRefGoogle Scholar
  35. 35.
    Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003; 51(3): 314–22PubMedCrossRefGoogle Scholar
  36. 36.
    Rantanen T, Guralnik JM, Foley D, et al. Midlife hand grip strength as a predictor of old age disability. JAMA 1999; 281(6): 558–60PubMedCrossRefGoogle Scholar
  37. 37.
    Rantanen T, Harris T, Leveille SG, et al. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 2000; 55(3): M168–73PubMedCrossRefGoogle Scholar
  38. 38.
    Newman AB, Kupelian V, Visser M, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006; 61(1): 72–7PubMedCrossRefGoogle Scholar
  39. 39.
    Davis HS, MacPherson K, Merry HR, et al. Reliability and validity of questions about exercise in the Canadian Study of Health and Aging. Int Psychogeriatr 2001; 13Suppl. 1: 177–82PubMedCrossRefGoogle Scholar
  40. 40.
    Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 1975; 12(3): 189–98CrossRefGoogle Scholar
  41. 41.
    Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–9PubMedCrossRefGoogle Scholar
  42. 42.
    Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67(6): 361–70PubMedCrossRefGoogle Scholar
  43. 43.
    Herrmann C. International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res 1997; 42(1): 17–41PubMedCrossRefGoogle Scholar
  44. 44.
    Fillenbaum GG, Smyer MA. The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 1981; 36(4): 428–34PubMedCrossRefGoogle Scholar
  45. 45.
    Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983; 31(12): 721–7PubMedGoogle Scholar
  46. 46.
    Barat I, Andreasen F, Damsgaard EM. The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 2000; 56(6–7): 501–9PubMedCrossRefGoogle Scholar
  47. 47.
    Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. Am J Geriatr Pharmacother 2008; 6(2): 119–29PubMedCrossRefGoogle Scholar
  48. 48.
    Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163(12): 1409–16PubMedCrossRefGoogle Scholar
  49. 49.
    Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002; 287(3): 337–44PubMedCrossRefGoogle Scholar
  50. 50.
    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(3): 123–30PubMedCrossRefGoogle Scholar
  51. 51.
    Markman M. Safety issues in using complementary and alternative medicine. J Clin Oncol 2002; 20(18 Suppl.): 39S–41SPubMedGoogle Scholar
  52. 52.
    Schlenk EA, Dunbar-Jacob J, Engberg S. Medication non-adherence among older adults: a review of strategies and interventions for improvement. J Gerontol Nurs 2004; 30(7): 33–43PubMedGoogle Scholar
  53. 53.
    Partridge AH, Avorn J, Wang PS, et al. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst 2002; 94(9): 652–61PubMedCrossRefGoogle Scholar
  54. 54.
    Partridge AH, Wang PS, Winer EP, et al. Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 2003; 21(4): 602–6PubMedCrossRefGoogle Scholar
  55. 55.
    Partridge AH, LaFountain A, Mayer E, et al. Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 2008; 26(4): 556–62PubMedCrossRefGoogle Scholar
  56. 56.
    McCowan C, Shearer J, Donnan PT, et al. Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. Br J Cancer 2008; 99(11): 1763–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Martine T. E. Puts
    • 1
    • 2
  • Beatriz Costa-Lima
    • 1
  • Johanne Monette
    • 1
    • 3
  • Veronique Girre
    • 3
    • 4
  • Christina Wolfson
    • 2
    • 5
  • Gerald Batist
    • 6
  • Howard Bergman
    • 1
    • 3
  1. 1.Solidage Research Group on Frailty and Aging, Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General HospitalMcGill UniversityMontrealCanada
  2. 2.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
  3. 3.Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General HospitalMcGill UniversityMontrealCanada
  4. 4.Department of Medical OncologyInstitut CurieParisFrance
  5. 5.Division of Clinical EpidemiologyMcGill University Health Centre (MUHC)MontrealCanada
  6. 6.Segal Cancer Centre, Jewish General HospitalMcGill UniversityMontrealCanada

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