Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management
ABSTRACT Older oncology patients with multiple comorbidities are at risk for adverse drug events associated with polypharmacy and drug-drug interactions due to patients' altered pharmacokinetic/pharmacodynamic status and the narrow therapeutic windows associated with anti-neoplastic agents. This study addresses the issue of polypharmacy and potential drug-drug interactions in outpatients in a community setting in the USA, and the prescribing behaviour of oncologists after being made aware of potential drug-drug interactions.
We performed a retrospective cohort study in patients with multiple comorbidities exposed to chemotherapy to profile the potential for adverse drug reactions and to define physicians' responses to risks arising from drug interactions. The medical records of 100 patients aged >or=70 years receiving chemotherapeutic agents at a community-based, university-affiliated medical practice were randomly selected and reviewed. Drug class usage was quantified, and potential drug-drug interactions were assessed and categorized. Treating oncologists were encouraged to modify their prescriptions on the basis of potential interactive drug evaluation reports. Physicians' responses were catalogued.
The mean age of the study population was 78 years (range, 70-90 years). Patients had an average of three comorbid conditions. Each patient received an average of 9 x 1 medications. Cardiovascular drugs were the most common medications that patients used to treat chronic conditions. Carboplatin and paclitaxel were the most frequently used chemotherapeutic agents. Inspite of the potential for drug-drug interactions, physicians made no adjustments to prescriptions.
Given that polypharmacy and the chronic use of multiple drugs are a reality for older patients with cancer and polymorbidities, outcome data need to be generated and motivations/incentives provided for physicians to optimize safe and effective supportive oncologic therapeutics.
- SourceAvailable from: Hasan Vakili-Arki
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- "One included study in our review reported the incidence of potential DDIs among cancer patients as 37.5% . A study conducted in a developed country has shown that 27% of cancer patients were subject to DDIs . Supporting the results of these studies, a review on DDIs among cancer patients reported that approximately one-third of cancer patients are susceptible to DDIs . "
ABSTRACT: Drug-drug interactions (DDIs) are an important type of adverse drug events. Yet overall incidence and pattern of DDIs in Iran has not been well documented and little information is available about the strategies that have been used for their prevention. The purpose of this study was to systematically review the literature on the incidence and pattern of DDIs in Iran as well as the used strategies for their prevention. PubMed, Scopus, electronic Persian databases, and Google Scholar were searched to identify published studies on DDIs in Iran. Additionally, the reference lists of all retrieved articles were reviewed to identify additional relevant articles. Eligible studies were those that analyzed original data on the incidence of DDIs in inpatient or outpatient settings in Iran. Articles about one specific DDI and drug interactions with herbs, diseases, and nutrients were excluded. The quality of included studies was assessed using quality assessment criteria. Database searches yielded 1053 potentially eligible citations. After removing duplicates, screening titles and abstracts, and reading full texts, 34 articles were found to be relevant. The quality assessment of the included studies showed a relatively poor quality. In terms of study setting, 18 and 16 studies have been conducted in inpatient and outpatient settings, respectively. All studies focused on potential DDIs while no study assessed actual DDIs. The median incidence of potential DDIs in outpatient settings was 8.5% per prescription while it was 19.2% in inpatient settings. The most indicated factor influencing DDIs incidence was patient age. The most involved drug classes in DDIs were beta blockers, angiotensin-converting-enzyme inhibitors (ACEIs), diuretic agents, and non-steroidal anti-inflammatory drugs (NSAIDs). Thirty-one studies were observational and three were experimental in which the strategies to reduce DDIs were applied. Although almost all studies concluded that the incidence of potential DDIs in Iran in both inpatient and outpatient settings was relatively high, there is still no evidence of the incidence of actual DDIs. More extensive research is needed to identify and minimize factors associated with incidence of DDIs, and to evaluate the effects of preventive interventions especially those that utilize information technology.DARU Journal of Pharmaceutical Sciences 06/2014; 22(1):52. DOI:10.1186/2008-2231-22-52 · 1.11 Impact Factor
- "medication use comprises 10 or more different drugs  . An increased risk of adverse drug reactions and reduced adherence to the medication regimen are problems that are often encountered in this population . "
Conference Paper: Reliability of microsystems from the material point of view[Show abstract] [Hide abstract]
ABSTRACT: The determination of the reliability of microsystems is very important from the customer satisfaction perspective. The reliability of electromechanical components is determined by using mechanical tests, metallographic investigations, nondestructive testing and corrosion tests. All tests are accelerated tests which determine the behaviour of a component or a system during hours, days or weeks with regard to their lifetime and are well known. The behaviour of these components under working conditions confirm the test results if the chosen tests characterise the real loads. In addition to the accelerated reliability tests, more and more simulation tools are used to optimise the design of a given component in order to reduce the costs and the time of development and testing and to increase the lifetime and reliability. To determine the thermo mechanical reliability, i.e. to reduce the mechanical stresses, which are mainly responsible for cracks under working conditions, stress-strain diagrams depending on temperature and strain velocity are urgently needed. The paper describes the necessity of material parameters which characterise the material under working conditions to obtain simulation results with high accuracy. However in microsystems the materials parameters as described are not known exactly at present.Microelectronics, 2002. MIEL 2002. 23rd International Conference on; 02/2002