Abstract
Background
Because of comorbidities and polypharmacy, older patients with cancer have a greater
risk of iatrogenic events. We aimed to characterize potential drug-drug interactions
(PDIs) and the risk of unplanned hospitalization in older patients with cancer treated
with antineoplastic agents (ANAs).
Methods
We analyzed all older patients (≥70 years) from the prospective ELCAPA cohort referred
for geriatric assessment (2007–2014) prior to treatment with ANA at Henri Mondor Hospital
(Créteil, France). PDIs were identified using Lexicomp®, and Theriaque® for French
medications. Factors associated with PDIs, and association between PDIs and unplanned
hospitalization in the 6 months following geriatric assessment were analyzed using
ordered multivariate logistic regression (MLR).
Results
We included 442 patients (median [interquartile range] age: 77 years [74–80]); number
of medications/patient/day: 6 [3–8]); ECOG-PS ≤ 2: 79%; metastasis: 70%). Most patients
had a digestive tract cancer (colorectal: 22%; upper digestive tract: 23%). We identified
1742 PDIs; 76.5% of patients had ≥1 PDI; 13% of the PDIs involved an ANA. In a multivariate
analysis, cardiovascular disorders (ischemic heart disease, heart failure, atrial
fibrillation and/or arterial hypertension) were independently associated with PDIs
(p < .001, after adjustment for polypharmacy and tumor site/stage). A high number of
PDIs between two daily medications was independently associated with the risk of unplanned
hospitalization (adjusted-odds ratio [95% confidence interval] per PDI: 1.05 [1.00;1.11],
p = .05), while polypharmacy was not.
Conclusion
Patients with cardiovascular comorbidities were more likely to have a PDI. A higher
number of PDIs may be an independent risk factor for early unplanned hospitalization.
Keywords
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Article info
Publication history
Published online: August 21, 2019
Accepted:
July 30,
2019
Received in revised form:
June 2,
2019
Received:
January 10,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
