Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management.

New Hope Cancer Center, Hudson, FL, USA.
Journal of Clinical Pharmacy and Therapeutics (Impact Factor: 1.53). 05/2007; 32(2):169-75. DOI: 10.1111/j.1365-2710.2007.00815.x
Source: PubMed

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.

  • [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
  • [Show abstract] [Hide abstract]
    ABSTRACT: Multidimensional <sup>1</sup>H NMR spectra of biomolecules dissolved in light water are contaminated by an intense water artifact. Generalized eigenvalue decomposition methods using congruent matrix pencils are used to separate the water artefact from the protein spectra. Due to the statistical separation process, however, noise is introduced into the reconstructed spectra. Hence Kernel-based denoising techniques are discussed to obtain noise- and artifact-free 2D NOESY NMR spectra of proteins.
    Neural Networks, 2004. Proceedings. 2004 IEEE International Joint Conference on; 08/2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: ZusammenfassungÄltere und alte Tumorpatienten sind interindividuell sehr verschieden, und auch bei Patienten derselben Altersgruppe ist eine große Variationsbreite festzustellen. Von Jüngeren unterscheiden sich diese Patienten aber dennoch in vielerlei Hinsicht: Das betrifft zum einen den Prozess der Therapieentscheidung und die Erwartungen an die Therapie. Relevante Unterschiede zu Jüngeren bestehen aber auch aufgrund altersphysiologischer Veränderungen und häufiger alterstypischer Komorbiditäten, die über eine verringerte funktionelle Reservekapazität die Toxizität einer Arzneimitteltherapie und die operationsassoziierte Morbidität und Letalität erhöhen können.
    Onkologie 01/2008; 31(3):1-5. DOI:10.1159/000127537 · 0.84 Impact Factor