Polypharmacy linked to higher hospitalization rates among older adults with cancer
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The use of five or more prescription medications before initiation of IV chemotherapy appeared associated with higher rates of inpatient hospitalizations among older adults with cancer, according to results of a retrospective, population-based study published in Journal of Geriatric Oncology.
“Polypharmacy is common among older adults with cancer, and the risk for drug-to-drug interactions increases with the number of concurrent drugs — from 13% with two concomitant medications to almost 100% with the use of eight or more medications,” Grace Lu-Yao, PhD, associate director of population science at Sidney Kimmel Cancer Center at Jefferson Health, told Healio. “However, studies examining the impact of polypharmacy on health care utilization among older adults with cancer treated with chemotherapy are limited.”
Lu-Yao and colleagues sought to assess the prevalence of polypharmacy — use of at least five unique medications — among patients aged 65 years and older diagnosed with lung (n = 7,309), breast (n = 5,490) or prostate cancer (n = 1,430) and treated with IV chemotherapy between 2011 and 2014.
Eligible patients had continuous Medicare Part D coverage 6 months before initiation of chemotherapy, continuous Part A and Part B coverage within 1 year before initiation of chemotherapy and at least 6 months continuous Part A and Part B coverage after receiving chemotherapy.
Researchers used Medicare Part D drug event files to assess polypharmacy status and grouped patients according to the number of medications they took 6 months prior to chemotherapy: zero to four medications (n = 1,609), five to nine medications (n = 4,935), 10 to 14 medications (n = 4,378) and 15 or more medications (n = 3,037).
During the 6 months before chemotherapy, patients with lung cancer took a median 11 medications (interquartile range [IQR], 7-15), followed by a median 10 medications (IQR, 7-14) among men with prostate cancer and a median nine medications (IQR, 6-13) among those with breast cancer.
Among men with prostate cancer, those who took between five and nine medications before chemotherapy, compared with fewer than five, had a 42% (incidence rate ratio [IRR] = 1.42; 95% CI, 1.02-1.97) higher rate of hospitalization, whereas those who took between 10 and 14 medications had a 75% (IRR = 1.75; 95% CI, 1.25-2.45) higher rate and those who took 15 or more medications had a 114% (IRR = 2.14; 95% CI, 1.49-3.05) higher rate.
Among patients with lung cancer, the rate of hospitalization was 36% (IRR = 1.36; 95% CI, 1.19-1.72) higher among those who took between five and nine medications, 49% (IRR = 1.49; 95% CI, 1.3-1.72) higher among those who took between 10 and 14 medications, and 82% (IRR = 1.82; 95% CI, 1.57-2.11) higher among those who took 15 or more medications, all compared with those who took less than five medications.
Further, patients with breast cancer who took between five and nine medications before chemotherapy had a 17% (IRR = 1.17; 95% CI, 1.01-1.37) higher rate of hospitalization compared with those who took less than five medications, whereas those who took between 10 and 14 medications had a 61% (IRR = 1.61; 95% CI, 1.37-1.89) higher rate and those who took 15 or more medications had a 101% (IRR = 2.01; 95% CI, 1.68-2.39) higher rate.
Limitations of the study included its retrospective design and certain residual confounding effects, such as cancer burden and existing comorbidities, according to the researchers.
“Given that there is a strong association between the number of medicines used before chemotherapy and the risk for hospitalizations, efforts to reduce polypharmacy are crucial for these high-risk patients,” Lu-Yao told Healio. “Our team is planning to conduct a prospective randomized controlled trial to determine whether improved medication management can reduce inpatient hospitalizations and other health care resource utilization.” – by Jennifer Southall
For more information:
Grace Lu-Yao, PhD, can be reached at Sidney Kimmel Cancer Center, 833 Chestnut St., Suite 311, Philadelphia, PA 19107; email: grace.luyao@jefferson.edu.
Disclosures: The study was funded by grants from Sidney Kimmel Cancer Center. Lu-Yao reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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