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Cancer survivors more likely to be prescribed multiple medications
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Cancer survivors had higher rates of multiple medication prescriptions, including opioids, than people without cancer, according to a study of prescription medication use published in Cancer.
Cancer survivors also had more than double the medication expenditure than controls.
In the United States, the population of cancer survivors is expected to reach 26.1 million by 2040. Cancer survivors have their own complex health needs, often for management of chronic conditions, according to Caitlin Murphy, PhD, assistant professor at Simmons Cancer Center of UT Southwestern Medical Center, and colleagues.
“In our team’s qualitative research, we heard countless stories from cancer survivors about their challenges managing so many prescriptions,” Murphy told HemOnc Today. “Or, they’d describe experiences adding medications to their prescription regimen simply to manage the side effects of another medication.”
Murphy and colleagues studied patterns of prescription medication use and polypharmacy among 5,216 cancer survivors and 19,588 matched noncancer controls.
Researchers defined polypharmacy as use of at least five unique medications.
Cancer survivors appeared more likely to be unemployed and covered by Medicaid or other public insurance. They also had a higher prevalence of chronic conditions and multiple comorbidities than noncancer controls.
Sixty-four percent (95% CI, 62.3-65.8) of cancer survivors were prescribed at least five unique medications compared with 51.5% (95% CI, 50.4-52.6) of noncancer controls.
Polypharmacy appeared consistent across cancer types, except for lung cancer (79.6%; 95% CI 75.6-83.7).
Among the cohort aged 18 to 39 years, 41.8% of cancer survivors had prescriptions for at least five unique medications compared with 20.8% of controls.
“In our study, I was particularly surprised by the large proportion of adolescent and young adult cancer survivors taking multiple prescription medications. In fact, the adolescent and young adult cancer survivors appeared more similar to older adults in their 50s without cancer,” Murphy said. “Despite the tendency to think about polypharmacy as a problem of only older cancer patients, our study highlights adolescent and young adult cancer survivors as an important population to study.”
Results also showed more cancer survivors received prescriptions for benzodiazepines and/or opioids than noncancer controls (10% vs. 5%).
Opioid and narcotic analgesic prescriptions more than doubled among cancer survivors who were diagnosed within the past year than those among noncancer controls (43%; 95% CI, 39.3-46.8 vs. 21.2%; 95% CI, 20.3-22.1). About 28.6% of cancer survivors who were diagnosed more than 1 year ago had prescriptions for opioids and/or narcotic analgesics.
Survivors also had more than double the prescription expenditure than controls (median, $1,633 vs. $784).
“Several studies have shown that taking multiple prescription medications increases risk for drug-drug interactions, adverse drug events and poor adherence,” Murphy said. “Our findings show the challenges of weighing risks and benefits of medications, either when patients are newly diagnosed with cancer or many years after completing cancer treatment. Better understanding the appropriateness of these medications may inform clinical efforts to improve management.”
Prior research has shown that cancer survivors often get lost in the transition from cancer care to primary care, according to Murphy. During the interim, medications may be poorly managed.
“We have a unique opportunity to use the ‘teachable moment’ when patients complete cancer treatment and incorporate medication management into survivorship care planning,” Murphy said. “Improving care coordination between oncology and primary care providers may also reduce the number of duplicative or unnecessary medications in survivors’ prescription regimens.” – by Cassie Homer
For more information:
Caitlin C. Murphy, PhD, MD, can be reached at Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., TX, 75390; email: caitlin.murphy@ utsouthwestern.edu.
Disclosures: Murphy reports grants from AcademyHealth, Agency for Healthcare Research and Quality, the National Center for Advancing Translational Sciences and the NCI. Please see the study for all other authors’ relevant financial disclosures.
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