Advertisement

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

  • Grace Lu-Yao
    Correspondence
    Corresponding author at: Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson, 834 Chestnut St, Suite 311, Philadelphia, PA 19107, USA.
    Affiliations
    Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA

    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA
    Search for articles by this author
  • Ginah Nightingale
    Affiliations
    Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
    Search for articles by this author
  • Nikita Nikita
    Affiliations
    Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA
    Search for articles by this author
  • Scott Keith
    Affiliations
    Division of Biostatistics, Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
    Search for articles by this author
  • Krupa Gandhi
    Affiliations
    Division of Biostatistics, Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
    Search for articles by this author
  • Kristine Swartz
    Affiliations
    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA

    Department of Medical Oncology, Jefferson Senior Adult Oncology Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
    Search for articles by this author
  • Ralph Zinner
    Affiliations
    Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA

    University of Kentucky Markey Cancer Center, Lexington Kentucky, USA
    Search for articles by this author
  • Swapnil Sharma
    Affiliations
    Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA
    Search for articles by this author
  • W.M. Kevin Kelly
    Affiliations
    Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA
    Search for articles by this author
  • Andrew Chapman
    Affiliations
    Sidney Kimmel Cancer Center (SKCC) at Jefferson Health, Philadelphia, PA, USA

    Department of Medical Oncology, Jefferson Senior Adult Oncology Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
    Search for articles by this author
Published:March 18, 2020DOI:https://doi.org/10.1016/j.jgo.2020.03.001

      Abstract

      Objectives

      Polypharmacy (≥5 concurrent medications) is common among older patients with cancer (48%–80%) and associated with increased frailty, morbidity, and mortality. This study examined the relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous (IV) chemotherapy.

      Materials and Methods

      The main data source was the Surveillance, Epidemiology, and End Results-Medicare linked files. Patients (≥65 years) were included if they were diagnosed with prostate (n = 1430), breast (n = 5490), or lung cancer (n = 7309) in 1991–2013 and received IV chemotherapy in 2011–2014. The number of medications during the six-month window pre-IV chemotherapy initiation determined polypharmacy status. Negative binomial models were used to assess the association between polypharmacy and post-chemotherapy inpatient hospitalization. The results were presented as incidence rate ratios.

      Results

      We identified 13,959 patients with prostate, breast, or lung cancer treated with IV chemotherapy. The median number of prescription medications during the six-month window pre-IV chemotherapy initiation was high: ten among patients with prostate cancer, nine among patients with breast cancer, and eleven among patients with lung cancer. Compared to patients taking <5 prescriptions, post-chemotherapy hospitalization rate for patients with prostate cancer was 42%, 75%, and 114% higher among those taking 5–9, 10–14, and 15+ medications, respectively. Patients with breast and lung cancer demonstrated similar patterns.

      Conclusion

      This large population-based study found that polypharmacy during the six-month window pre-IV chemotherapy is highly predictive of post-chemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce post-chemotherapy inpatient hospitalization among older patients with cancer.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berger N.A.
        • Savvides P.
        • Koroukian S.M.
        • Kahana E.F.
        • Deimling G.T.
        • Rose J.H.
        • et al.
        Cancer in the elderly.
        Trans Am Clin Climatol Assoc. 2006; 117: 147-156
        • Bluethmann S.M.
        • Mariotto A.B.
        • Rowland J.H.
        Anticipating the “Silver Tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States.
        Cancer Epidemiol Biomarkers Prev. 2016; 25: 1029
        • Chapman A.
        • MacKenzie A.
        • Parker I.
        Silver oncologic tsunami: quality issues in the senior adult oncology population.
        J Oncol Pract. 2015; 11: 190-192
        • Stewart R.B.
        Polypharmacy in the elderly: A fait accompli?.
        SAGE Publications, 1990
        • Montamat S.C.
        • Cusack B.
        Overcoming problems with polypharmacy and drug misuse in the elderly.
        Clin Geriatr Med. 1992; 8: 143-158
        • Hajjar E.R.
        • Cafiero A.C.
        • Hanlon J.T.
        Polypharmacy in elderly patients.
        Am J Geriatr Pharmacother. 2007; 5: 345-351
        • Nightingale G.
        • Skonecki E.
        • Boparai M.K.
        The impact of polypharmacy on patient outcomes in older adults with cancer.
        Cancer J. 2017; 23
        • Prybys K.
        • Melville K.
        • Hanna J.
        • Gee A.
        • Chyka P.
        Polypharmacy in the elderly: clinical challenges in emergency practice: part 1: overview, etiology, and drug intercations.
        Emerg Med Rep. 2002; 23: 145-153
        • Fulton M.M.
        • Allen E.R.
        Polypharmacy in the elderly: a literature review.
        J Am Acad Nurse Pract. 2005; 17: 123-132
        • Dimitrow M.S.
        • Airaksinen M.S.
        • Kivelä S.L.
        • Lyles A.
        • Leikola S.N.
        Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review.
        J Am Geriatr Soc. 2011; 59: 1521-1530
        • 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 Clin Oncol. 2015; 33: 1453-1459
        • Karuturi M.S.
        • Holmes H.M.
        • Lei X.
        • Johnson M.
        • Barcenas C.H.
        • Cantor S.B.
        • et al.
        Potentially inappropriate medication use in older patients with breast and colorectal cancer.
        Cancer. 2018; 124: 3000-3007
        • Feng X.
        • Higa G.M.
        • Safarudin F.
        • Sambamoorthi U.
        • Tan X.
        Potentially inappropriate medication use and associated healthcare utilization and costs among older adults with colorectal, breast, and prostate cancers.
        J Geriatr Oncol. September 2019; 10: 698-704
        • Canoui-Poitrine F.
        • Reinald N.
        • Laurent M.
        • Guery E.
        • Caillet P.
        • David J.P.
        • et al.
        Geriatric assessment findings independently associated with clinical depression in 1092 older patients with cancer: the ELCAPA cohort study.
        Psycho-Oncol. 2016; 25: 104-111
        • Pamoukdjian F.
        • Aparicio T.
        • Zelek L.
        • Boubaya M.
        • Caillet P.
        • François V.
        • et al.
        Impaired mobility, depressed mood, cognitive impairment and polypharmacy are independently associated with disability in older cancer outpatients: the prospective physical frailty in elderly Cancer patients (PF-EC) cohort study.
        J Geriatric Oncol. 2017; 8: 190-195
        • Partridge J.S.
        • Harari D.
        • Martin F.C.
        • Dhesi J.K.
        The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review.
        Anaesthesia. 2014; 69: 8-16
        • Rajasekaran T.
        • Tan T.
        • Ong W.S.
        • Koo K.N.
        • Chan L.
        • Poon D.
        • et al.
        Comprehensive geriatric assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.
        J Geriatr Oncol. 2016; 7: 211-218
        • Choi K.S.
        • Jeong Y.M.
        • Lee E.
        • Kim K.I.
        • Yee J.
        • Lee B.K.
        • et al.
        Association of pre-operative medication use with post-surgery mortality and morbidity in oncology patients receiving comprehensive geriatric assessment.
        Aging Clin Exp Res. 2018; 30: 1177-1185
        • American Geriatrics Society 2015
        Updated beers criteria for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2015; 63: 2227-2246
        • Gallagher P.
        • O’Mahony D.
        STOPP (screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria.
        Age Ageing. 2008; 37: 673-679
        • O’Mahony D.
        • Gallagher P.
        • Ryan C.
        • Byrne S.
        • Hamilton H.
        • Barry P.
        • et al.
        STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age.
        Eur Geriatric Med. 2010; 1: 45-51
        • O’mahony D.
        • O’sullivan D.
        • Byrne S.
        • O’connor M.N.
        • Ryan C.
        • Gallagher P.
        STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
        Age Ageing. 2015; 44: 213-218
        • Sharma M.
        • Loh K.P.
        • Nightingale G.
        • Mohile S.G.
        • Holmes H.M.
        Polypharmacy and potentially inappropriate medication use in geriatric oncology.
        J Geriatr Oncol. 2016; 7: 346-353
        • Leger D.Y.
        • Moreau S.
        • Signol N.
        • Fargeas J.B.
        • Picat M.A.
        • Penot A.
        • et al.
        Polypharmacy, potentially inappropriate medications and drug-drug interactions in geriatric patients with hematologic malignancy: observational single-center study of 122 patients.
        J Geriatr Oncol. 2018; 9: 60-67
        • Reis C.M.
        • Dos Santos A.G.
        • de Jesus Souza P.
        • Reis A.M.M.
        Factors associated with the use of potentially inappropriate medications by older adults with cancer.
        J Geriatr Oncol. 2017; 8: 303-307
        • Rouge Bugat M.E.
        • Bourgouin M.
        • Gerard S.
        • Lozano S.
        • Brechemier D.
        • Cestac P.
        • et al.
        Drug prescription including interactions with anticancer treatments in the elderly: a global approach.
        J Nutr Health Aging. 2017; 21: 849-854
        • Saunders N.D.
        • Nichols S.D.
        • Antiporda M.A.
        • Johnson K.
        • Walker K.
        • Nilsson R.
        • et al.
        Examination of unplanned 30-day readmissions to a comprehensive Cancer hospital.
        J Oncol Pract. 2015; 11 (e177-e81)
        • Leendertse A.J.
        • Egberts A.G.
        • Stoker L.J.
        • van den Bemt P.A.
        • Group HS
        Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands.
        Arch Intern Med. 2008; 168: 1890-1896
        • Hartholt K.A.
        • van der Velde N.
        • Looman C.W.
        • Panneman M.J.
        • van Beeck E.F.
        • Patka P.
        • et al.
        Adverse drug reactions related hospital admissions in persons aged 60 years and over, the Netherlands, 1981-2007: less rapid increase, different drugs.
        PLoS One. 2010; 5e13977
        • Maggiore R.J.
        • Dale W.
        • Gross C.P.
        • Feng T.
        • Tew W.P.
        • Mohile S.G.
        • et al.
        Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment.
        J Am Geriatr Soc. 2014; 62: 1505-1512
        • Hohl C.M.
        • Dankoff J.
        • Colacone A.
        • Afilalo M.
        Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department.
        Ann Emerg Med. 2001; 38: 666-671
        • Warren J.L.
        • Klabunde C.N.
        • Schrag D.
        • Bach P.B.
        • Riley G.F.
        Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.
        Med Care. 2002; 40 (IV-3-18)
        • Warren J.L.K.C.
        • Schrag D.
        • Bach P.B.
        • Riley G.F.
        Overview of the SEER-medicare data: content, research applications, and generalizability to the united states elderly population.
        Med Care. 2002 Aug; 40: 3-18
        • Park J.W.
        • Roh J.-L.
        • Lee S.-w.
        • Kim S.-B.
        • Choi S.-H.
        • Nam S.Y.
        • et al.
        Effect of polypharmacy and potentially inappropriate medications on treatment and posttreatment courses in elderly patients with head and neck cancer.
        J Cancer Res Clin Oncol. 2016; 142: 1031-1040
        • O’Neill C.B.
        • Atoria C.L.
        • O’Reilly E.M.
        • Henman M.C.
        • Bach P.B.
        • Elkin E.B.
        • et al.
        ReCAP: hospitalizations in older adults with advanced Cancer: the role of chemotherapy.
        J Oncol Pract. 2016; 12: 151-152
        • Salvi F.
        • Marchetti A.
        • D’Angelo F.
        • Boemi M.
        • Lattanzio F.
        • Cherubini A.
        Adverse drug events as a cause of hospitalization in older adults.
        Drug Saf. 2012; 35: 29-45
        • Nightingale G.
        • Schwartz R.
        • Kachur E.
        • Dixon B.N.
        • Cote C.
        • Barlow A.
        • et al.
        Clinical pharmacology of oncology agents in older adults: a comprehensive review of how chronologic and functional age can influence treatment-related effects.
        J Geriatric Oncol. 2019; 10: 4-30
        • Prybys K.
        • Gee A.
        Polypharmacy in the elderly: clinical challenges in emergency practice. Part 1 overview, etiology, and drug interactions.
        Emerg Med Rep. 2002; 23: 145-151