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Drug prescription including interactions with anticancer treatments in the elderly: A global approach

  • Published:
The journal of nutrition, health & aging

Abstract

Background

Consequences of inappropriate prescriptions and polymedication in patients suffering from cancer are beginning to be well documented. However, the methods used to evaluate these consequences are often discussed. Few studies evaluate the risk of interaction with anticancer drugs in elderly patients suffering from cancer.

Objectives

To describe the prevalence (i) of polypharmacy, (ii) of potentially inappropriate drug prescriptions and (iii) of drug interactions involving anticancer treatments, using a multiple reference tools.

Design

A retrospective, cross-sectional, multicenter study performed from January to December 2012.

Participants

Patients aged 65 years or older suffering from cancer presented at the oncogeriatric multidisciplinary meeting.

Measurements

Polymedication (>6 drugs), potentially inappropriate prescriptions and drug interactions involving anticancer treatment were analyzed in combination with explicit and implicit criteria within a global approach.

Results

Among the 106 patients included in this study, polypharmacy was present in 60.4% of cases, potentially inappropriate drug prescription in 63.1% and drug interactions in 16% of case, of which 47% involved anti-cancer treatments. Twenty-seven major drug interactions were identified and eight interactions involved chemotherapy.

Conclusion

Polymedication, inappropriate prescribing and drug interactions involving anti-cancer drugs are common and largely underestimated in elderly cancer patients.

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References

  1. Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012 Jul 01;118(13): 3377–86.

    Article  PubMed  Google Scholar 

  2. Caillet P, Laurent M, Bastuji-Garin S, Liuu E, Culine S, Lagrange JL, et al. Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment. Clin interventions aging. 2014;9:1645–60.

    Google Scholar 

  3. Gerard S, Brechemier D, Lefort A, Lozano S, Abellan Van Kan G, Filleron T, et al. Body Composition and Anti-Neoplastic Treatment in Adult and Older Subjects- A Systematic Review. J Nutr Health Aging. 2016;20(8): 878–88.

    Article  CAS  PubMed  Google Scholar 

  4. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011 Sep 01;29(25): 3457–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Alkan A, Yasar A, Karci E, Koksoy EB, Urun M, Senler FC, et al. Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients. Supportive Care Cancer. 2017 Jan;25(1): 229–36.

    Article  Google Scholar 

  6. Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J J Clin Oncol. 2015 May 01;33(13): 1453–9.

    Article  PubMed  Google Scholar 

  7. Saarelainen LK, Turner JP, Shakib S, Singhal N, Hogan-Doran J, Prowse R, et al. Potentially inappropriate medication use in older people with cancer: prevalence and correlates. J Geriatric Oncol. 2014 Oct 01;5(4): 439–46.

    Article  Google Scholar 

  8. Popa MA, Wallace KJ, Brunello A, Extermann M, Balducci L. Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy. J Geriatric Oncol. 2014 Jul;5(3): 307–14.

    Article  Google Scholar 

  9. Tam-McDevitt J. Polypharmacy, aging, and cancer. Oncology. 2008 Aug;22(9): 1052–5, discussion 5, 8, 60.

    PubMed  Google Scholar 

  10. Turner JP, Jamsen KM, Shakib S, Singhal N, Prowse R, Bell JS. Polypharmacy cutpoints in older people with cancer: how many medications are too many? Supportive Care Cancer. 2016 Apr;24(4): 1831–40.

  11. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007 Jul 14;370(9582): 173–84.

    Article  PubMed  Google Scholar 

  12. O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing. 2008 Mar;37(2): 138–41.

  13. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatrics Soc. 2015 Nov;63(11): 2227–46.

    Article  Google Scholar 

  14. Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007 Aug;63(8): 725–31.

    Article  PubMed  Google Scholar 

  15. Recoche I, Lebaudy C, Cool C, Sourdet S, Piau A, Lapeyre-Mestre M, et al. Potentially inappropriate prescribing in a population of frail elderly people. Int J Clin Pharmacol. 2016 Dec 10.

    Google Scholar 

  16. Cool C, Cestac P, Laborde C, Lebaudy C, Rouch L, Lepage B, et al. Potentially inappropriate drug prescribing and associated factors in nursing homes. J Am Med Dir Asso. 2014;15(11):850 e1–9.

    Article  Google Scholar 

  17. Rouge Bugat ME, Brechemier D, Balardy L. Polypharmacy and Potentially Inappropriate Medication Use Among Senior Adults With Cancer: What Is the Best Approach? J Clin Oncol. 2015 Dec 01;33(34): 4123–4.

    Article  PubMed  Google Scholar 

  18. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994 Nov;47(11): 1245–51.

    Article  CAS  PubMed  Google Scholar 

  19. Solomon DH. Geriatric assessment: methods for clinical decision making. JAMA. 1988 Apr 22-29;259(16): 2450–2.

    Article  CAS  PubMed  Google Scholar 

  20. Trentini M, Semeraro S, Motta M. Effectiveness of geriatric evaluation and care. Oneyear results of a multicenter randomized clinical trial. Aging. 2001 Oct;13(5): 395–405.

    CAS  Google Scholar 

  21. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psy Res. 1975 Nov;12(3):189–98.

    CAS  Google Scholar 

  22. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963 Sep 21;185:914–9.

    CAS  PubMed  Google Scholar 

  23. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969 Autumn;9(3): 179–86.

    Article  CAS  PubMed  Google Scholar 

  24. Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, et al. Overview of the MNA—Its history and challenges. J Nutr Health Aging. 2006 Nov-Dec;10(6): 456–63; discussion 63-5.

    CAS  PubMed  Google Scholar 

  25. Farhat SC, Silva CA, Orione MA, Campos LM, Sallum AM, Braga AL. Air pollution in autoimmune rheumatic diseases: a review. Autoimmunity Reviews. 2011 Nov;11(1): 14–21.

    Article  CAS  PubMed  Google Scholar 

  26. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012 Sep;65(9): 989–95.

    Article  PubMed  Google Scholar 

  27. Moulis F, Moulis G, Balardy L, Gerard S, Sourdet S, Rouge-Bugat ME, et al. Searching for a polypharmacy threshold associated with frailty. J Am Med Dir Asso. 2015 Mar;16(3): 259–61.

    Article  Google Scholar 

  28. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/ START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015 Mar;44(2): 213–8.

    Article  PubMed  Google Scholar 

  29. Scripture CD, Figg WD. Drug interactions in cancer therapy. Nature Rev Cancer. 2006 Jul;6(7): 546–58.

    Article  CAS  Google Scholar 

  30. Beijnen JH, Schellens JH. Drug interactions in oncology. Lancet Oncol. 2004 Aug;5(8): 489–96.

    Article  CAS  PubMed  Google Scholar 

  31. Ussai S, Petelin R, Giordano A, Malinconico M, Cirillo D, Pentimalli F. A pilot study on the impact of known drug-drug interactions in cancer patients. J Exp Clin Cancer Res. 2015 Aug 25;34:89.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ussai S, Miceli L, Pisa FE, Bednarova R, Giordano A, Della Rocca G, et al. Impact of potential inappropriate NSAIDs use in chronic pain. Drug Des Dev Therapy. 2015;9:2073–7.

    Article  CAS  Google Scholar 

  33. Flood KL, Carroll MB, Le CV, Brown CJ. Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncologyacute care for elders unit. Am J Ger Pharmaco. 2009 Jun;7(3): 151–8.

    Article  Google Scholar 

  34. Girre V, Arkoub H, Puts MT, Vantelon C, Blanchard F, Droz JP, et al. Potential drug interactions in elderly cancer patients. Critical Rev Oncol Hematol. 2011 Jun;78(3):220–6.

    Article  CAS  Google Scholar 

  35. Lees J, Chan A. Polypharmacy in elderly patients with cancer: clinical implications and management. Lancet Oncol. 2011 Dec;12(13): 1249–57.

    Article  PubMed  Google Scholar 

  36. Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. Oncologist. 2010;15(5): 507–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. Inappropriate prescribing predicts adverse drug events in older adults. Annals Pharmaco. 2010 Jun;44(6): 957–63.

    Article  Google Scholar 

  38. Prithviraj GK, Koroukian S, Margevicius S, Berger NA, Bagai R, Owusu C. Patient Characteristics Associated with Polypharmacy and Inappropriate Prescribing of Medications among Older Adults with Cancer. J Ger Oncol. 2012 Jul 01;3(3): 228–37.

    Article  Google Scholar 

  39. Schepisi R, Fusco S, Sganga F, Falcone B, Vetrano DL, Abbatecola A, et al. Inappropriate Use of Proton Pump Inhibitors in Elderly Patients Discharged from Acute Care Hospitals. J Nutr Health Aging. 2016;20(6): 665–70.

    Article  CAS  PubMed  Google Scholar 

  40. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011 Apr;56(4): 931–50.

    Article  CAS  PubMed  Google Scholar 

  41. Fohl AL, Regal RE. Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all? World J Gastro Pharmacol Ther. 2011 Jun 06;2(3): 17–26.

    Article  Google Scholar 

  42. Bucsa C, Farcas A, Cazacu I, Leucuta D, Achimas-Cadariu A, Mogosan C, et al. How many potential drug-drug interactions cause adverse drug reactions in hospitalized patients? Eur J Int Med. 2013 Jan;24(1): 27–33.

    Article  Google Scholar 

  43. Puts MT, Costa-Lima B, Monette J, Girre V, Wolfson C, Batist G, et al. Medication problems in older, newly diagnosed cancer patients in Canada: How common are they? A prospective pilot study. Drugs Aging. 2009;26(6): 519–36.

    Article  PubMed  Google Scholar 

  44. Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care. Eur J Clin Pharmacol. 2013 Mar;69(3): 565–71.

    Article  CAS  PubMed  Google Scholar 

  45. Egger SS, Drewe J, Schlienger RG. Potential drug-drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol. 2003 Mar;58(11):773–8.

    Article  PubMed  Google Scholar 

  46. Geppert U, Beindl W, Hawranek T, Hintner H. Drug interactions in clinical practice. A pilot project for quality assurance in prescribing. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 2003 Jan;54(1): 53–7.

    Article  CAS  PubMed  Google Scholar 

  47. Kenis C, Heeren P, Decoster L, Van Puyvelde K, Conings G, Cornelis F, et al. A Belgian Survey on Geriatric Assessment in Oncology Focusing on Large-Scale Implementation and Related Barriers and Facilitators. J Nutr Health Aging. 2016 Jan;20(1): 60–70.

    Article  CAS  PubMed  Google Scholar 

  48. Hurkens KP, Mestres-Gonzalvo C, de Wit HA, van der Kuy PH, Janknegt R, Verhey F, et al. Usually Available Clinical and Laboratory Data Are Insufficient for a Valid Medication Review: A Crossover Study. J Nutr Health Aging. 2016 Jan;20(1): 71–6.

  49. Kojima T, Mizukami K, Tomita N, Arai H, Ohrui T, Eto M, et al. Screening Tool for Older Persons’ Appropriate Prescriptions in Japanese: Report of the Japan Geriatrics Society Working Group on “Guidelines for medical treatment and its safety in the elderly”. Ger Gerontol Int. 2016 Sep;16(9): 983–1001.

    Article  Google Scholar 

  50. Clyne B, Smith SM, Hughes CM, Boland F, Bradley MC, Cooper JA, et al. Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTISCRIPT Study). Ann Fam Med. 2015 Nov;13(6): 545–53.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nightingale G, Hajjar E, Guo K, Komura S, Urnoski E, Sendecki J, et al. A pharmacistled medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. J Ger Oncol. 2015 Sep;6(5): 411–7.

    Article  Google Scholar 

  52. Leveque D, Delpeuch A, Gourieux B. New anticancer agents: role of clinical pharmacy services. Anticancer Res. 2014 Apr;34(4): 1573–8.

    CAS  PubMed  Google Scholar 

  53. Lopez-Martin C, Garrido Siles M, Alcaide-Garcia J, Faus Felipe V. Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience. Int J Clin Pharm. 2014 Dec;36(6): 1251–9.

    Article  PubMed  Google Scholar 

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Correspondence to Marie-Eve Rougé Bugat.

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Rougé Bugat, ME., Bourgouin, M., Gérard, S. et al. Drug prescription including interactions with anticancer treatments in the elderly: A global approach. J Nutr Health Aging 21, 849–854 (2017). https://doi.org/10.1007/s12603-017-0946-8

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  • DOI: https://doi.org/10.1007/s12603-017-0946-8

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