Abstract
Polypharmacy is characterized by the simultaneous use of multiple medications, including
prescription drugs, over-the-counter drugs, and nutritional supplements. Polypharmacy
is known to increase the risk of adverse drugs reactions, drug-drug interactions,
and medication errors, and to negatively impact quality of life. The prevalence of
polypharmacy varies by population, but has been reported to exceed 90% among older
adults with cancer. Polypharmacy may be exacerbated among older adults with cancer
receiving radiation therapy due to the resulting acute or chronic side effects that
need to be managed with additional medications. The medications prescribed to manage
radiation-related side effects increase the risk of adverse drug events, as do changes
in nutritional status related to the secondary side effects of radiation treatment.
Side effects from treatment may result in the need for breaks in cancer therapy or
treatment delays, which ultimately can lead to worse oncologic outcomes. Few studies
have examined polypharmacy in the context of older adults undergoing radiation therapy.
We sought to review the literature pertaining to polypharmacy among older adults with
cancer and discuss implications specifically for those individuals undergoing radiation
therapy. This paper presents a narrative review of studies published in the past decade
that provided detailed information on polypharmacy in older adults undergoing radiation
therapy for cancer. The review elucidated good practices to avoid adverse drug events
from polypharmacy, but more studies are warranted to develop standard guidelines.
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 accessOne-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 OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The State of Aging and Health in America.www.cdc.gov/agingwww.miahonline.org(Accessed March 22, 2021)Date: 2004
- What is polypharmacy? A systematic review of definitions.BMC Geriatr. 2017; 17https://doi.org/10.1186/s12877-017-0621-2
- Polypharmacy: correlations with sex, age and drug regimen.Eur J Clin Pharmacol. 1998; 54: 197-202https://doi.org/10.1007/s002280050445
- 2019 AGS Beers criteria for older adults.Pharm Today. 2019; 25: 42-54https://doi.org/10.1016/j.ptdy.2019.10.022
- STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age.Eur Geriatr Med. 2010; 1: 45-51https://doi.org/10.1016/j.eurger.2010.01.007
- An overview of prevalence, determinants and health outcomes of polypharmacy.Ther Adv drug Saf. 2020; 11 (2042098620933741)https://doi.org/10.1177/2042098620933741
- An increasing trend in the prevalence of Polypharmacy in Sweden: A Nationwide register-based study.Front Pharmacol. 2020; 11: 326https://doi.org/10.3389/fphar.2020.00326
- The epidemiology of polypharmacy in older adults: register-based prospective cohort study.Clin Epidemiol. 2018; 10: 289-298https://doi.org/10.2147/CLEP.S153458
- Race/ethnicity, socioeconomic status, and polypharmacy among older Americans.Pharmacy. 2019; 7: 41https://doi.org/10.3390/pharmacy7020041
- Assessment of regional variation in polypharmacy.Pharmacoepidemiol Drug Saf. 2010; 19: 375-383https://doi.org/10.1002/pds.1921
- Prevalence of poly-pharmacy in the elderly: implications of age, gender, co-morbidities and drug interactions.SOJ Pharm Pharm Sci. 2014; https://doi.org/10.15226/2374-6866/1/3/00115
- Strategies to improve radiotherapy with targeted drugs.Nat Rev Cancer. 2011; 11: 239-253https://doi.org/10.1038/nrc3007
- Polypharmacy in older patients ≥70 years receiving palliative radiotherapy | anticancer research.
- Prevalence and risk of Polypharmacy among elderly Cancer patients receiving chemotherapy in ambulatory oncology setting.Curr Oncol Rep. 2018; 20https://doi.org/10.1007/S11912-018-0686-X
- Patient characteristics associated with polypharmacy and inappropriate prescribing of medications among older adults with cancer.J Geriatr Oncol. 2012; 3: 228-237https://doi.org/10.1016/j.jgo.2012.02.005
- 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: 1453-1459https://doi.org/10.1200/JCO.2014.58.7550
- Implementing a pharmacist-led, individualized medication assessment and planning (iMAP) intervention to reduce medication related problems among older adults with cancer.J Geriatr Oncol. 2017; 8: 296-302https://doi.org/10.1016/j.jgo.2017.04.005
- Associations of Polypharmacy and inappropriate medications with adverse outcomes in older adults with Cancer: A systematic review and Meta-analysis.Oncologist. 2020; 25https://doi.org/10.1634/theoncologist.2019-0406
- Systematic review and Meta-analysis on the associations of Polypharmacy and potentially inappropriate medication with adverse outcomes in older Cancer patients.J Gerontol Ser A. May 2020; https://doi.org/10.1093/gerona/glaa128
- The impact of polypharmacy on patient outcomes in older adults with cancer.Cancer J (United States). 2017; 23: 211-218https://doi.org/10.1097/PPO.0000000000000277
- 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: 1031-1040https://doi.org/10.1007/s00432-015-2108-x
- Polypharmacy in older patients ≥70 years receiving palliative radiotherapy.Anticancer Res. 2017; 37: 795-800https://doi.org/10.21873/anticanres.11379
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383https://doi.org/10.1016/0021-9681(87)90171-8
- Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: Asco guideline for geriatric oncology.J Clin Oncol. 2018; 36: 2326-2347https://doi.org/10.1200/JCO.2018.78.8687
- International society of geriatric oncology consensus on geriatric assessment in older patients with cancer.J Clin Oncol. 2014; 32: 2595-2603https://doi.org/10.1200/JCO.2013.54.8347
- The NCCN Clinical Practice Guidelines in Oncology Older Adult Oncology (version 1.2021).National Comprehensive Cancer Network, Inc. 2021; (www.NCCN.org, (accessed 2022 February 1)): 22-23
- The role of comprehensive geriatric assessment in radiation oncology.J Geriatr Oncol. 2020; 11: 194-196https://doi.org/10.1016/j.jgo.2019.08.012
- Polypharmacy in patients with advanced cancer and pain: a European cross-sectional study of 2282 patients.J Pain Symptom Manage. 2014; 48: 1145-1159https://doi.org/10.1016/J.JPAINSYMMAN.2014.03.008
- American Geriatrics Society 2019 updated AGS Beers criteria® for potentially inappropriate medication use in older adults.J Am Geriatr Soc. 2019; 67: 674-694https://doi.org/10.1111/jgs.15767
- A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity.J Clin Epidemiol. 1994; 47: 891-896https://doi.org/10.1016/0895-4356(94)90192-9
- A comprehensive look at Polypharmacy and medication screening tools for the older Cancer patient.Oncologist. 2016; 21: 723-730https://doi.org/10.1634/theoncologist.2015-0492
- Reducing inappropriate polypharmacy: the process of deprescribing.JAMA Intern Med. 2015; 175: 827-834https://doi.org/10.1001/jamainternmed.2015.0324
- Discontinuing medications: A novel approach for revising the prescribing stage of the medication-use process.J Am Geriatr Soc. 2008; 56: 1946-1952https://doi.org/10.1111/j.1532-5415.2008.01916.x
- Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures.J Am Geriatr Soc. 2015; 63: e8-e18https://doi.org/10.1111/jgs.13807
- Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults.Br J Nutr. 2004; 92: 799-808https://doi.org/10.1079/bjn20041258
- Nutritional risk, nutritional status and incident disability in older adults. The FRADEA study.J Nutr Health Aging. 2014; 18: 270-276https://doi.org/10.1007/s12603-013-0388-x
- Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment.J Am Geriatr Soc. 2010; 58: 1734-1738https://doi.org/10.1111/j.1532-5415.2010.03016.x
- Nutritional status and drug therapy in older adults.J Gerontol Geriat Res. 2013; 2https://doi.org/10.4172/2167-7182.1000123
- An evaluation of nutrition intervention during radiation therapy in patients with locoregionally advanced nasopharyngeal carcinoma.Oncotarget. 2017; 8: 83723-83733https://doi.org/10.18632/oncotarget.19381
- A prospective analysis of factors that influence weight loss in patients undergoing radiotherapy.Chin J Cancer. 2014; 33: 204-210https://doi.org/10.5732/cjc.013.10009
- Malnutrition and the role of nutritional support for radiation therapy patients.Recent Results Cancer Res. 1988; 108: 205-226https://doi.org/10.1007/978-3-642-82932-1_27
- Alterations of nutritional status. Impact of chemotherapy and radiation therapy.Cancer. 1979; 43: 2036-2052https://doi.org/10.1002/1097-0142(197905)43:5+<2036::AID-CNCR2820430712>3.0.CO;2–7
- High weight loss during radiation treatment changes the prognosis in under-/Normal weight nasopharyngeal carcinoma patients for the worse: A retrospective analysis of 2433 cases.PLoS One. 2013; 8https://doi.org/10.1371/journal.pone.0068660
- Factors associated with malnutrition in hospitalized cancer patients: A croos-sectional study.Nutr J. 2015; 14https://doi.org/10.1186/s12937-015-0113-1
- Acad Nutr Diet Evid Anal Libr.2016
- Dietary Supplement Use Among Adults: United States, 2017–2018.February 2021https://doi.org/10.15620/CDC:101131
- Antioxidant vitamins supplementation and mortality: A randomized trial in head and neck cancer patients.Int J Cancer. 2006; 119: 2221-2224https://doi.org/10.1002/ijc.22042
- A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients.J Natl Cancer Inst. 2005; 97: 481-488https://doi.org/10.1093/jnci/dji095
- Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long-term effects on recurrence and mortality: A randomized trial among head and neck cancer patients.Int J Cancer. 2008; 122: 1679-1683https://doi.org/10.1002/ijc.23200
- Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: A double-blind randomized trial.Head Neck. 2004; 26: 313-321https://doi.org/10.1002/hed.10382
- Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients.J Clin Oncol. 2005; 23: 5805-5813https://doi.org/10.1200/JCO.2005.05.514
- Mega-dose vitamins and minerals in the treatment of non-metastatic breast cancer: an historical cohort study.Breast Cancer Res Treat. 2002; 76: 137-143https://doi.org/10.1023/A:1020552501345
Possible interactions between dietary antioxidants and chemotherapy - PubMedhttps://pubmed.ncbi.nlm.nih.gov/10442346/. Accessed October 12, 2021.
- Reduced effect of irradiation on normal and malignant cells irradiated in vivo in mice pretreated with vitamin E.Br J Radiol. 1973; 46: 538-540https://doi.org/10.1259/0007-1285-46-547-538
- Effects of diet and nutrition on drug therapy.J Am Geriatr Soc. 1982; 30: S99-S112https://doi.org/10.1111/j.1532-5415.1982.tb01364.x
- Integrative Medicine: Search About Herbs | Memorial Sloan Kettering Cancer Center.(Accessed March 23, 2021)
- Managing the Adverse Effects of Radiation Therapy.Vol 82. 2010 (Accessed March 17, 2021)
- Supportive care: an indispensable component of modern oncology.Clin Oncol. 2020; 32: 781-788https://doi.org/10.1016/j.clon.2020.07.020
- Future of cancer incidence in the United States: burdens upon an aging, changing nation.J Clin Oncol. 2009; 27: 2758-2765https://doi.org/10.1200/JCO.2008.20.8983
- A method for assessing drug therapy appropriateness.J Clin Epidemiol. 1992; 45: 1045-1051https://doi.org/10.1016/0895-4356(92)90144-C
Article info
Publication history
Published online: February 25, 2022
Accepted:
February 10,
2022
Received in revised form:
December 9,
2021
Received:
June 14,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
