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: 1.67). 05/2007; 32(2):169-75. DOI: 10.1111/j.1365-2710.2007.00815.x
Source: PubMed


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.

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    • "These observations are associated with well-known facts concerning the effect of age-related processes on the renal function , which may undergo exacerbation under the influence of anticancer chemotherapy. The risk factors for constipation in elderly patients include, among other things, improper diet, decreased intake of fluids, decreased physical activity, stress associated with hospitalization, and the use of drugs [16]. The OPTIMOX studies on the safety of the FOLFOX-4 regimen in elderly patients (> 75 years of age) revealed a significantly elevated incidence of neutropenia and peripheral neuropathy of severity grade 3–4 in comparison to patients ≤ 75 years of age [17]. "
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    ABSTRACT: Modern anticancer chemotherapy can cause numerous adverse effects in the organism, whose functioning has already been disrupted by the neoplastic process itself. The aim of the study was to evaluate and compare the frequency and severity of the toxicity of FOLFOX-4 and CLF-1 anticancer therapy in patients with colon cancer, and to analyze certain factors that might have increased the toxicity of the chemotherapy. The study involved 64 patients suffering from generalized colon cancer, including 48 patients treated according to the FOLFOX-4 regimen and 16 patients treated according to the CLF-1 regimen. The toxicity of each regimen was analyzed on the basis of a confidential questionnaire formulated by the authors and laboratory research according to the extended WHO toxicity criteria. The analysis of the symptoms of toxicity symptoms associated with the use of the FOLFOX-4 and CLF-1 therapeutic regimens revealed that the most common side effects included nausea and vomiting, despite ondansetron premedication, and neurotoxicity. Disruption of the functioning of the nervous system under the FOLFOX-4 regimen statistically significant exacerbation that increased with the number of chemotherapy cycles administered; this was more common and more severe in women. Paresthesia was also revealed to be a neurotoxic effect of the FOLFOX-4 regimen after termination of therapy. A statistically significant relationship was observed between the use of vitamin supplements and the incidence and severity of the toxicity of the FOLFOX-4 regimen. The findings of the current study regarding the toxicity of the FOLFOX-4 and CLF-1 therapy regimens should be taken into consideration when monitoring chemotherapy safety in colon cancer. The patients' tolerance of the administered medication and the side effects reported by patients should be constantly evaluated, which will help prevent these side effects, apply appropriate therapy and contribute to the improvement of the patients' quality of life. The functioning of the central nervous system should be carefully evaluated when planning the anticancer therapy, especially if repeated administration of neurotoxic drugs is necessary in cases of a recurrence of the disease. Chemotherapy should be thoroughly monitored for safety, especially in women over 65 years of age suffering from coexisting diseases. Colon cancer patients and their families should be informed of the risks of nutritional supplements before the start of the anticancer chemotherapy, and may need to dispense with their use.
    Advances in Clinical and Experimental Medicine 04/2015; 24(1):103-11. DOI:10.17219/acem/38154 · 1.10 Impact Factor
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    • "One included study in our review reported the incidence of potential DDIs among cancer patients as 37.5% [57]. A study conducted in a developed country has shown that 27% of cancer patients were subject to DDIs [62]. 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 [21]. "
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    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 · 1.64 Impact Factor
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    • "medication use comprises 10 or more different drugs [4] [5]. An increased risk of adverse drug reactions and reduced adherence to the medication regimen are problems that are often encountered in this population [6]. "
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    ABSTRACT: Background: We studied the use of Lexicomp®, an online drug information database, for adequate identification of drug-drug interactions (DDIs) within Comprehensive Geriatric Assessment (CGA) in cancer patients. Materials and Methods: Data of 149 onco-geriatric patients were reviewed. Sixty-three percent participated in an observational study recruiting head and neck cancer patients (H&N-group), 37% in a registry recruiting general oncology patients (GO-group). Baseline drug information was collected by a health professional, through the medical interview within CGA. Drug class usage was quantified and potential DDIs were assessed and categorized (risk rating "C": monitor therapy, "D": consider therapy modification, "X": avoid combination) with Lexicomp®. Results: On average, H&N and GO-patients took 5 and 8 prescription drugs at presentation, respectively. An average of 4 drugs were added in both groups as part of their proposed therapy. Potential DDIs (n=211 H&N; n=247 GO) were detected by Lexicomp® in 64.9% (85.3% "C", 14.7% "D", 0% "X") and 83.6% (83.4% "C", 15.8% "D", 0.8% "X") of H&N and GO patients, respectively, at therapy start. Administration of cancer-therapy-related drugs lead to additional DDIs (n=75 H&N; n=68 GO) in 73.7% and 58.3% of H&N and GO cases, respectively. DDIs occurred mainly with supportive drugs (100% H&N and 83.8% GO). Sixteen percent of potential DDIs were identified with anti-neoplastic drugs in the GO-group. In 28.7% and 60.0% of H&N and GO patients, respectively, at least one drug was not recognized by Lexicomp®. Conclusions: Use of Lexicomp® drug database within CGA is feasible. It could reduce the administration of inappropriate drugs, and in that way improve the quality of patient-individualized therapy.
    Journal of Analytical Oncology 01/2012; 1(1):32. DOI:10.6000/1927-7229.2012.01.01.5
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