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Association between polypharmacy and health-related quality of life among cancer survivors in the United States

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Abstract

Purpose

Polypharmacy (PP) is present in many cancer survivors and may lead to lower health-related quality of life (HRQoL). The study’s objective was to evaluate the association between PP and HRQoL among cancer survivors in the US.

Methods

A cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) was conducted. Our analytic sample included all adult patients with cancer, during even years 2008–2014. PP was defined as reported use of five or more unique therapeutic classes of prescription medications. The MEPS measured HRQoL using the Short Form 12-Item Health Survey Version 2 (SF-12v2) physical component summary (PCS) and mental component summary (MCS) scores. Ordinary least squares regressions were used to assess associations between PP and HRQoL controlling for demographic, socioeconomic, and clinical factors.

Results

PP was prevalent among 44.4% of 10.1 million cancer survivors per calendar year (on average) for years 2008, 2010, 2012, and 2014. The mean adjusted PCS score for cancer survivors with PP was 35.8 points, which was significantly lower compared with cancer survivors without PP (39.5) by 3.7 points (p value < .0001). Conversely, the mean adjusted MCS scores were not significantly lower in cancer survivors with PP compared with cancer survivors without PP (44.9 versus 45.4, p value = 0.3145).

Conclusions

PP was prevalent in 44.4% of cancer survivors and was associated with significantly poorer physical HRQoL than reported in their counterparts without PP.

Implications for Cancer Survivors

PP should be examined closely among cancer survivors because of increased association with poorer physical HRQoL.

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References

  1. NCI Dictionary of Cancer Terms was originally produced by the National Cancer Institute. Available Online: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivorship. Accessed May 31, 2019

  2. Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA, et al. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2012;21(11):2108–17. https://doi.org/10.1158/1055-9965.EPI-12-0740.

    Article  Google Scholar 

  3. Cancer treatment & survivorship facts & figures 2016–2017 is accompanied by “Cancer Treatment and Survivorship Statistics, 2016,” a scientific paper published in the American Cancer Society Journal, CA: A Cancer Journal for Clinicians.

  4. Koch L, Jansen L, Brenner H, Arndt V. Fear of recurrence and disease progression in long-term (≥ 5 years) cancer survivors–a systematic review of quantitative studies. Psychooncology. 2013;22(1):1–11. https://doi.org/10.1002/pon.3022 Review.

    Article  CAS  PubMed  Google Scholar 

  5. Rowland JH, Bellizzi KM. Cancer survivorship issues: life after treatment and implications for an aging population. J Clin Oncol. 2014;32(24):2662–8. https://doi.org/10.1200/JCO.2014.55.8361 Review.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Murphy CC, Fulling HM, Alvarez CA, et al. Polypharmacy and patterns of prescription medication use among cancer survivors. Cancer. 2018;1:124(13). https://doi.org/10.1002/cncr.31389.

    Article  Google Scholar 

  7. Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013;5(Suppl 1):3–29. https://doi.org/10.2147/CLEP.S47150 Review.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Loh KY, Ng T, Lee CP, Ng R, Chan A. Medication use by early-stage breast cancer survivors: a 1-year longitudinal study. Support Care Cancer. 2016;24(4):1639–47. https://doi.org/10.1007/s00520-015-2950-z.

    Article  PubMed  Google Scholar 

  9. Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. Oncologist. 2010;15(5):507–22. https://doi.org/10.1634/theoncologist.2009-0290 Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. van Leeuwen RWF, Brundel DHS, Neef C, van Gelder T, Mathijssen RH, Burger DM, et al. Prevalence of potential drug-drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer. 2013;108(5):1071–8. https://doi.org/10.1038/bjc.2013.48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. van Leeuwen RWF, Jansman FGA, Van den Bemt, et al. Drug-drug interactions in patients treated for cancer: a prospective study on clinical interventions. Ann Oncol 2015;26(5):992–997. https://doi.org/10.1093/annonc/mdv029.

    Article  CAS  Google Scholar 

  12. Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol. 2007;46(4):417–32 Review.

    Article  Google Scholar 

  13. National Cancer Institute (NCI). Late effects of treatment for childhood cancer (PDQ®)–patient version was originally published by the National Cancer Institute. Available Online: https://www.cancer.gov/types/childhood-cancers/late-effects-pdq. Accessed May 31, 2019.

  14. Lu R, Krull KR, Leisenring W, et al. Pain in long-term adult survivors of childhood cancers and their siblings: a report from the childhood cancer survivor study. Pain. 2011;152(11):2616–24. https://doi.org/10.1016/j.pain.2011.08.006.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Limper AH. Chemotherapy-induced lung disease. Clin Chest Med. 2004;25(1):53–64. Review. https://doi.org/10.1016/S0272-5231(03)00123-0.

    Article  PubMed  Google Scholar 

  16. Meraya AM, Dwibedi N, Sambamoorthi U. Polypharmacy and health-related quality of life among US adults with arthritis, medical expenditure panel survey, 2010-2012. Prev Chronic Dis. 2016;13:E132. https://doi.org/10.5888/pcd13.160092.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Medical expenditure panel survey; agency for healthcare research and quality. available: https://meps.ahrq.gov/mepsweb/. Accessed May 31, 2019

  18. Agency for healthcare research and quality. Medical expenditure panel survey, HC-138: 2010 Full Year Consolidated Data File; 2012. https://meps.ahrq.gov/data_stats/download_data/pufs/h138/h138doc.pdf. Accessed May 31, 2019.

  19. Machlin S, Soni A, Fang Z. Understanding and analyzing MEPS household component medical condition data. Available Online: https://meps.ahrq.gov/survey_comp/MEPS_condition_data.shtml. Accessed May 31, 2019.

  20. Wang SY, Hsu SH, Gross CP, Sanft T, Davidoff AJ, Ma X, et al. Association between time since cancer diagnosis and health-related quality of life: a population-level analysis. Value Health. 2016;19(5):631–8. https://doi.org/10.1016/j.jval.2016.02.010.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sera L, McPherson ML, Holmes HM. Commonly prescribed medications in a population of hospice patients. Am J Hosp Palliat Care. 2014;31(2):126–31. https://doi.org/10.1177/1049909113476132.

    Article  PubMed  Google Scholar 

  22. Cheak-Zamora NC, Wyrwich KW, McBride TD. Reliability and validity of the SF12-v2 in the medical expenditure panel survey. Qual Life Res. 2009;18(6):727–35. https://doi.org/10.1007/s11136-009-9483-1.

    Article  PubMed  Google Scholar 

  23. Park J, Look KA. Relationship between objective financial burden and the health-related quality of life and mental health of patients with cancer. J Oncol Pract. 2018;14(2):e113–21. https://doi.org/10.1200/JOP.2017.027136.

    Article  PubMed  Google Scholar 

  24. Bhandari NR, Kathe N, Hayes C, Payakachat N. Reliability and validity of SF-12v2 among adults with self-reported cancer. Res Social Adm Pharm. 2018;14(11):1080–4. https://doi.org/10.1016/j.sapharm.2018.01.007.

    Article  PubMed  Google Scholar 

  25. Masnoon N, Shakib S, Kalisch-Ellett L, Caughry GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2 Review.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Agency for healthcare research and quality. Medical expenditure panel survey, HC-135A: 2010 Prescribed Medicines; 2012. https://meps.ahrq.gov/data_stats/download_data/pufs/h135a/h135adoc.pdf. Accessed May 31, 2019.

  27. Vyas A, Babcock Z, Kogut S. Impact of depression treatment on health-related quality of life among adults with cancer and depression: a population-level analysis. J Cancer Surviv. 2017;11(5):624–33. https://doi.org/10.1007/s11764-017-0635-y.

    Article  PubMed  Google Scholar 

  28. Yuan Y. Multiple imputation using SAS software. J Stat Software. 2011;45(6):ISSN: 1548–7660 (Online).

    Article  Google Scholar 

  29. Smith C, Kosten S. Multiple imputation: a statistical programming story. PharmaSUG 2017 Paper SP01. Available Online: https://pharmasug.org/proceedings/2017/SP/PharmaSUG-2017-SP01.pdf. Accessed May 31, 2019.

  30. MEPS Topics: Medical conditions file. Medical Expenditure Panel Survey; Agency for Healthcare Research and Quality. Available: https://meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=32Z-1. Accessed May 31, 2019.

  31. Kleinbaum DG, Klein M. Logistic regression: a self-learning text. 3rd ed. New York: Springer; 2010.

    Book  Google Scholar 

  32. Vyas A, Pan X, Sambamoorthi U. Chronic condition clusters and polypharmacy among adults. Int J Family Med. 2012;2012:193168. https://doi.org/10.1155/2012/193168.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Turner JP, Jamsen KS, Shakib S, Singhal N, Prowse R, Bell JS. Polypharmacy cut-points in older people with cancer: how many medications are too many? Support Care Cancer. 2016;24(4):1831–40. https://doi.org/10.1007/s00520-015-2970-8.

    Article  PubMed  Google Scholar 

  34. Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM. Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol. 2016;7(5):346–53. https://doi.org/10.1016/j.jgo.2016.07.010 Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Popa MA, Wallace KJ, Brunello A, Extermann M, Balducci L. Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy. J Geriatr Oncol. 2014;5(3):307–14. https://doi.org/10.1016/j.jgo.2014.04.002.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lees J, Chan A. Polypharmacy in elderly patients with cancer: clinical implications and management. Lancet Oncol. 2011;12(13):1249–57. https://doi.org/10.1016/S1470-2045(11)70040-7 Review.

    Article  PubMed  Google Scholar 

  37. Cheung AS, de Rooy C, Hoermann R, Joon DL, Zajac JD, Grossmann M. Quality of life decrements in men with prostate cancer undergoing androgen deprivation therapy. Clin Endocrinol. 2017;86(3):388–94. https://doi.org/10.1111/cen.13249.

    Article  CAS  Google Scholar 

  38. Roydhouse JK, Gutman R, Keating NL, Mor V, Wilson IB. Proxy and patient reports of health-related quality of life in a national cancer survey. Health Qual Life Outcomes. 2018;16(1):6. https://doi.org/10.1186/s12955-017-0823-5.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ware J Jr, Gandek B, Sinclair SJ, et al. Measuring and improving health outcomes: an SF-36 primer for the Medicare health outcomes survey. Health assessment lab and QualityMetric incorporated, Waltham; 2004.

  40. LeMasters T, Madhavan S, Sambamoorthi U, Kurian S. A population-based study comparing HRQoL among breast, prostate, and colorectal cancer survivors to propensity score matched controls, by cancer type, and gender. Psychooncology. 2013;22(10):2270–82. https://doi.org/10.1002/pon.3288.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Greenwald HP, McCorkle R, Baumgartner K, Carolyn G, Neale AV. Quality of life and disparities among long-term cervical cancer survivors. J Cancer Surviv. 2014;8:419–26. https://doi.org/10.1007/s11764-014-0352-8.

    Article  PubMed  Google Scholar 

  42. Corcoran ME. Polypharmacy in the older patient with cancer. Cancer Control. 1997;4(5):419–28.

    Article  CAS  Google Scholar 

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Correspondence to Zachary R. Babcock.

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Babcock, Z.R., Kogut, S.J. & Vyas, A. Association between polypharmacy and health-related quality of life among cancer survivors in the United States. J Cancer Surviv 14, 89–99 (2020). https://doi.org/10.1007/s11764-019-00837-y

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