151
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Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM. Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol 2016; 7:346-53. [PMID: 27498305 DOI: 10.1016/j.jgo.2016.07.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/22/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods.
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Affiliation(s)
- Manvi Sharma
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
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152
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Koll T, Pergolotti M, Holmes HM, Pieters HC, van Londen GJ, Marcum ZA, MacKenzie AR, Steer CB. Supportive Care in Older Adults with Cancer: Across the Continuum. Curr Oncol Rep 2016; 18:51. [PMID: 27342609 PMCID: PMC5504916 DOI: 10.1007/s11912-016-0535-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.
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Affiliation(s)
- Thuy Koll
- Internal Medicine Division of Geriatric Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, 68198-6155, NE, USA
| | - Mackenzi Pergolotti
- Cancer Outcomes Research Group, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, UTHealth, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin, MSB 5.116, Houston, 77030, TX, USA
| | | | - G J van Londen
- University of Pittsburgh, S. 140 Cooper Pavilion, 5115 Centre Ave., Pittsburgh, 15232, PA, USA
| | - Zachary A Marcum
- University of Washington, 1959 NE Pacific Ave, H375G, Box 357630, Seattle, 98195, WA, USA
| | - Amy R MacKenzie
- Department of Medical Oncology, Division of Regional Cancer Care, Thomas Jefferson University, 925 Chestnut St., 4th floor, Philadelphia, 9107, PA, USA
| | - Christopher B Steer
- Border Medical Oncology, Suite 1, 69 Nordsvan Drive, Wodonga, 3690, VIC, Australia.
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153
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Holle LM, Harris CS, Chan A, Fahrenbruch RJ, Labdi BA, Mohs JE, Norris LB, Perkins J, Vela CM. Pharmacists' roles in oncology pharmacy services: Results of a global survey. J Oncol Pharm Pract 2016; 23:185-194. [DOI: 10.1177/1078155216629827] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oncology pharmacists are capable of providing medication therapy management (MTM) because of their level of training, practice experiences, and responsibilities. Very little data exist about their current practice, including changing roles in the multidisciplinary team, overall impact, and effects in the education of patients and healthcare professionals. Methods A 70-item survey about oncology pharmacists' activities in oral chemotherapy programs, MTM, and collaborative practice agreements (CPAs) was deployed using a web survey tool (Qualtrics, Provo, UT, USA), targeting pharmacist members of American College of Clinical Pharmacy (ACCP) Hematology/Oncology Practice and Research Network (PRN). The objective of this study was to determine oncology pharmacists' activities in areas of oral chemotherapy programs, MTM, and CPAs. A cross-sectional survey was distributed to the ACCP Hematology/Oncology PRN membership. Investigational Review Board approval was obtained. Results Of the 795 members who were sent the survey, 81 members (10%) responded; 33 respondents (47%) are involved with an oral chemotherapy program; with 42% measuring outcomes of programs. Only six pharmacists (19%) have published or presented their data. A total of 28 (35%) respondents provide MTM services, with almost half (43%) of these MTM services being dictated by CPAs. A small fraction of these pharmacists (21.4%) reported conducting quality assurance evaluations of their MTM services and three pharmacists (10.7%) reported publishing their results. Those pharmacists practicing under CPAs ( n = 28) were surveyed as to activities included in their CPA. The most common activities included adjusting medication, ordering, interpreting, and monitoring lab tests, developing therapeutic plans and educating patients. Reimbursement for providing these services was uncommon: MTM (4%), oral chemotherapy program (6%), and CPA services (11%). Reported obstacles to reimbursement included lack of understanding, administrative assistance, or time with setting up reimbursement models within the institution. Conclusion Many oncology pharmacists are participating in oral chemotherapy programs, MTM, and/or CPAs and perceived barriers were identified. Increased efforts should be directed toward prospectively reporting and assessing the impact these services have on patient care.
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Affiliation(s)
- Lisa M Holle
- Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA
| | - Christy S Harris
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rebecca J Fahrenbruch
- Fairview Pharmacy Services, University of Minnesota Health Cancer Care, Burnsville, MN, USA
| | - Bonnie A Labdi
- Department of Pharmacy, Memorial Hermann Cancer Center – TMC, Houston, TX, USA
| | - Jocelyn E Mohs
- Oncology/Specialty Pharmacy Services, St. Cloud Veterans Affairs Health Care System, St. Cloud, MN, USA
| | - Leann B Norris
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Columbia, SC, USA
| | - Janelle Perkins
- Department of Pharmacotherapy and Clinical Research, University of South Florida College of Pharmacy, Tampa, FL, USA
| | - Cory M Vela
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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154
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Jeong YM, Lee E, Kim KI, Chung JE, In Park H, Lee BK, Gwak HS. Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. BMC Geriatr 2016; 16:134. [PMID: 27388509 PMCID: PMC4937600 DOI: 10.1186/s12877-016-0311-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/22/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). METHODS A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R(2). Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). RESULTS Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ(2) = 3.842, p = 0.871 for model I and χ(2) = 8.130, p = 0.421 for model II). The Nagelkerke R(2) effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R(2)effect size of 0.174 and AUROC of 0.819. CONCLUSIONS These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.
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Affiliation(s)
- Young Mi Jeong
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.,Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Jee Eun Chung
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Hae In Park
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Byung Koo Lee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
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155
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Bemben NM. Deprescribing: An Application to Medication Management in Older Adults. Pharmacotherapy 2016; 36:774-80. [DOI: 10.1002/phar.1776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nina M. Bemben
- University of Maryland School of Pharmacy; Department of Pharmacy Practice and Science; Baltimore Maryland
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156
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Guerard EJ, Nightingale G, Bellizzi K, Burhenn P, Rosko A, Artz AS, Korc-Grodzicki B, Canin B, Dale W, Ferrell B. Survivorship care for older adults with cancer: U13 conference report. J Geriatr Oncol 2016; 7:305-12. [PMID: 27424802 PMCID: PMC4969136 DOI: 10.1016/j.jgo.2016.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
Older adult cancer survivors currently account for almost 60% of all cancer survivors. The number of older cancer survivors will continue to increase as the population ages and as patients' live longer after a cancer diagnosis. As part of cancer center accreditation, the American College of Surgeons Commission on Cancer® (CoC) has placed great importance on survivorship care planning. While the CoC has set standards for general survivorship care, there is sparse evidence on how to best care for older adult cancer survivors. Concern exists among the medical community that survivorship care plans could increase paperwork without improving outcomes. Given the diverse and unique needs of older adult cancer survivors, the inter-professional team provides a structure and process for survivorship care built around the particular needs of older adults. The Cancer and Aging Research Group (CARG), in partnership with the NIA/NCI, held a U13 conference in May 2015 in part to discuss survivorship care for older adults with cancer. This report discusses four themes that emerged from one section of the conference: (1) survivorship care is a process that continually evolves to meet the needs of older adults; (2) older adult cancer survivors have unique needs and care plans should be tailored to meet these needs; (3) the inter-professional team is ideally suited to structure survivorship care of older adults; (4) patient advocacy must be encouraged throughout the cancer care continuum. As evidence based survivorship practices develop, the unique needs of older adults need to be given substantial attention.
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Affiliation(s)
- Emily J Guerard
- University of North Carolina at Chapel Hill, Division of Hematology and Oncology, 170 Manning Drive Campus Box 7305, Chapel Hill, NC 27599-7305, USA.
| | - Ginah Nightingale
- Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut Street Suite 946, Philadelphia, PA 19107-5233, USA
| | - Keith Bellizzi
- Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, Unit 2058,, Storrs, CT 06269, USA
| | | | - Ashley Rosko
- Ohio State University, Division of Hematology, Columbus, OH, USA
| | - Andrew S Artz
- University of Chicago, Section of Hematology and Oncology, Chicago, IL, USA
| | - Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, Geriatrics Service, Department of Medicine, New York, NY, USA
| | | | - William Dale
- University of Chicago, Department of Medicine, Section of Geriatrics and Palliative Medicine and Hematology/Oncology, Chicago, IL, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, City of Hope, Duarte, CA, USA
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157
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Deliens C, Deliens G, Filleul O, Pepersack T, Awada A, Piccart M, Praet JP, Lago LD. Drugs prescribed for patients hospitalized in a geriatric oncology unit: Potentially inappropriate medications and impact of a clinical pharmacist. J Geriatr Oncol 2016; 7:463-470. [PMID: 27238734 DOI: 10.1016/j.jgo.2016.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/15/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the prevalence of potentially inappropriate medication (PIM) use upon admission and at discharge in a geriatric oncology unit after involving a clinical pharmacist. Although the few studies conducted in geriatric oncology units used the 2003 Beers criteria, this study used START and STOPP criteria, a more appropriate tool for European formularies. MATERIALS AND METHODS Prospective study in older (≥70years) patients consecutively admitted to a geriatric oncology unit in a cancer center from July 2011 to April 2012. Clinical pharmacist conducted a complete comprehensive medication review including non-prescription and complementary (herbals) medications. This information coupled with the patient's medical history allows identifying PIMs using the STOPP and START criteria. The number of PIMs at admission and at discharge from the hospital was compared after clinical pharmacist intervention. RESULTS Ninety-one older patients with cancer (mean age±SD=79±6years) were included in the study. START criteria identified 41 PIMs for 31 persons (34%) at admission compared to 7 PIMs for 6 persons (7%) at discharge. STOPP criteria identified 50 PIMs at admission for 29 persons (32%) compared to 16 PIMs at discharge for 14 persons (16%). Results showed significantly lower START scores at discharge than at admission (p<0.001); similarly, STOPP criteria demonstrated fewer PIMs at discharge than at admission (p<0.001). CONCLUSION The use of START and STOPP criteria by a clinical pharmacist allows identifying PIMs and changing prescriptions for older patients with cancer in agreement with the oncologist and geriatrician of the team.
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Affiliation(s)
- Coralie Deliens
- Division of Pharmacy, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet, 1000 Brussels, Belgium.
| | - Gaétane Deliens
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, 50 avenue F.D. Rooselvelt, 1050 Brussels, Belgium.
| | - Olivier Filleul
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet, 1000 Brussels, Belgium.
| | - Thierry Pepersack
- Department of Geriatric Medicine, C.H.U St.-Pierre, 322 rue Haute, 1000 Brussels, Belgium.
| | - Ahmad Awada
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet, 1000 Brussels, Belgium.
| | - Martine Piccart
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet, 1000 Brussels, Belgium.
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, C.H.U St.-Pierre, 322 rue Haute, 1000 Brussels, Belgium.
| | - Lissandra Dal Lago
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet, 1000 Brussels, Belgium.
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158
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Whitman AM, DeGregory KA, Morris AL, Ramsdale EE. A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient. Oncologist 2016; 21:723-30. [PMID: 27151653 DOI: 10.1634/theoncologist.2015-0492] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/22/2016] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED : Inappropriate medication use and polypharmacy are extremely common among older adults. Numerous studies have discussed the importance of a comprehensive medication assessment in the general geriatric population. However, only a handful of studies have evaluated inappropriate medication use in the geriatric oncology patient. Almost a dozen medication screening tools exist for the older adult. Each available tool has the potential to improve aspects of the care of older cancer patients, but no single tool has been developed for this population. We extensively reviewed the literature (MEDLINE, PubMed) to evaluate and summarize the most relevant medication screening tools for older patients with cancer. Findings of this review support the use of several screening tools concurrently for the elderly patient with cancer. A deprescribing tool should be developed and included in a comprehensive geriatric oncology assessment. Finally, prospective studies are needed to evaluate such a tool to determine its feasibility and impact in older patients with cancer. IMPLICATIONS FOR PRACTICE The prevalence of polypharmacy increases with advancing age. Older adults are more susceptible to adverse effects of medications. "Prescribing cascades" are common, whereas "deprescribing" remains uncommon; thus, older patients tend to accumulate medications over time. Older patients with cancer are at high risk for adverse drug events, in part because of the complexity and intensity of cancer treatment. Additionally, a cancer diagnosis often alters assessments of life expectancy, clinical status, and competing risk. Screening for polypharmacy and potentially inappropriate medications could reduce the risk for adverse drug events, enhance quality of life, and reduce health care spending for older cancer patients.
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Affiliation(s)
- Andrew M Whitman
- Department of Pharmacy Services, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kathlene A DeGregory
- Department of Pharmacy Services, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amy L Morris
- Department of Pharmacy Services, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Erika E Ramsdale
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA
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159
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Finkelstein J, Friedman C, Hripcsak G, Cabrera M. Potential utility of precision medicine for older adults with polypharmacy: a case series study. Pharmgenomics Pers Med 2016; 9:31-45. [PMID: 27143951 PMCID: PMC4846041 DOI: 10.2147/pgpm.s101474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as "CYP3A4/CYP3A5 poor metabolizer", which affected metabolism of eleven prescribed drugs. The second case had "CYP2D6 rapid metabolizer" status affecting three prescribed medications, two of which were key drugs for managing this patient's chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug-drug interactions. Both patients with significant drug-gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides providing convincing evidence of its clinical effectiveness, multiple barriers must be addressed. Introduction of intelligent clinical decision support in electronic medical record systems is required to address complexities of simultaneous drug-gene and drug-drug interactions in older adults with polypharmacy. Physician training, clear clinical pathways, evidence-based guidelines, and patient education materials are necessary for unlocking full potential of pharmacogenomics into routine clinical care of older adults.
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Affiliation(s)
- Joseph Finkelstein
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Carol Friedman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Manuel Cabrera
- Department of Medicine, Columbia University, New York, NY, USA
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160
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Stepney R. Supportive care vital in elderly cancer patients : A report from the 2015 annual conference of the International Society of Geriatric Oncology (SIOG), which focused on the role of supportive care in geriatric oncology. Support Care Cancer 2016; 24:2397-401. [PMID: 26984244 DOI: 10.1007/s00520-016-3172-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/08/2016] [Indexed: 12/11/2022]
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161
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Stepney R. Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology. Cancer Biol Med 2016; 13. [PMCID: PMC4850124 DOI: 10.28092/j.issn.2095-3941.2016.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.
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Affiliation(s)
- Rob Stepney
- Freelance Medical Writer. Charlbury, OX7 3HJ, UK
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162
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Lipp HP, Miller K. Therapie des metastasierten kastrationsresistenten Prostatakarzinoms. Urologe A 2016; 55:766-71. [DOI: 10.1007/s00120-016-0049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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163
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Lichtman SM. Geriatricizing Oncology Care: Older Women With Breast Cancer. J Oncol Pract 2016; 12:135-6. [DOI: 10.1200/jop.2015.010397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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164
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Abstract
Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival (OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.
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Affiliation(s)
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 11725, USA
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165
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Woopen H, Richter R, Ismaeel F, Chekerov R, Roots I, Siepmann T, Sehouli J. The influence of polypharmacy on grade III/IV toxicity, prior discontinuation of chemotherapy and overall survival in ovarian cancer. Gynecol Oncol 2016; 140:554-8. [PMID: 26790772 DOI: 10.1016/j.ygyno.2016.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ovarian cancer is mostly diagnosed in the elderly woman who is likely to have comorbid disease and to take several comedications on a regular basis. Aim of this study was to evaluate the influence of polypharmacy on grade III/IV toxicity, prior discontinuation of chemotherapy and survival. PATIENTS AND METHODS In this individual participant data meta-analysis the original data of three phase II/III studies of the North-Eastern German Society of Gynecological Oncology (NOGGO) were analyzed using multivariate logistic and Cox regression. RESULTS Overall, 1213 patients with recurrent ovarian cancer were included in these analyses. An increasing amount of medication was associated with overall grade III/IV toxicity (p<0.001; OR 1.120), and hematological (p<0.001; OR 1.056) and non-hematological (p<0.001; OR 1.134) toxicities. Prior discontinuation of chemotherapy was not influenced by an increasing amount of medication (p=0.196). There was no association of polypharmacy with overall survival (p=0.068). CONCLUSION As polypharmacy does not influence survival ovarian cancer patients taking several comedications may be included in clinical trials and should not be deprived of adequate cancer treatment. However, a thorough monitoring is mandatory due to the increased risk of toxicities.
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Affiliation(s)
- H Woopen
- European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany; Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Freiberger Str. 37, 01067 Dresden, Germany.
| | - R Richter
- European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Ismaeel
- European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - R Chekerov
- European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - I Roots
- Institute of Clinical Pharmacology and Toxicology, Charité - University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - T Siepmann
- Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Freiberger Str. 37, 01067 Dresden, Germany
| | - J Sehouli
- European Competence Center for Ovarian Cancer (EKZE), Department of Gynecology, Charité - University Medicine of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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166
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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; 142:1031-40. [DOI: 10.1007/s00432-015-2108-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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167
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Todd A, Husband A, Andrew I, Pearson SA, Lindsey L, Holmes H. Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review. BMJ Support Palliat Care 2016; 7:113-121. [DOI: 10.1136/bmjspcare-2015-000941] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/09/2015] [Accepted: 11/25/2015] [Indexed: 12/20/2022]
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168
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Nightingale G, Swartz K, Chapman AE. Reply to M.-E. Rougé Bugat et al. J Clin Oncol 2015; 33:4124-5. [DOI: 10.1200/jco.2015.63.4311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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169
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Rougé Bugat ME, Bréchemier D, Balardy L. Polypharmacy and Potentially Inappropriate Medication Use Among Senior Adults With Cancer: What Is the Best Approach? J Clin Oncol 2015; 33:4123-4. [DOI: 10.1200/jco.2015.62.8149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marie-Eve Rougé Bugat
- Institut Universitaire du Cancer–Oncopole, Université Paul Sabatier Toulouse III, and Institut National de la Santé et de la Recherche Médicale–UPS, Toulouse, France
| | | | - Laurent Balardy
- Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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170
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Mangoni AA, Pilotto A. New drugs and patient-centred end-points in old age: setting the wheels in motion. Expert Rev Clin Pharmacol 2015; 9:81-9. [PMID: 26455964 DOI: 10.1586/17512433.2016.1100074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Older patients with various degrees of frailty and disability, a key population target of pharmacological interventions in acute and chronic disease states, are virtually neglected in pre-marketing studies assessing the efficacy and safety of investigational drugs. Moreover, aggressively pursuing established therapeutic targets in old age, e.g. blood pressure, serum glucose or cholesterol concentrations, is not necessarily associated with the beneficial effects, and the acceptable safety, reported in younger patient cohorts. Measures of self-reported health and functional status might represent additional, more meaningful, therapeutic end-points in the older population, particularly in patients with significant frailty and relatively short life expectancy, e.g. in the presence of cancer and/or neurodegenerative disease conditions. Strategies enhancing early knowledge about key pharmacological characteristics of investigational drugs targeting older adults are discussed, together with the rationale for incorporating non-traditional, patient-centred, end-points in this ever-increasing group.
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Affiliation(s)
- Arduino A Mangoni
- a Discipline of Clinical Pharmacology, School of Medicine , Flinders University and Flinders Medical Centre , Bedford Park , Australia
| | - Alberto Pilotto
- b Department of Orthogeriatrics, Rehabilitation and Stabilization, Frailty Area , E.O. Galliera Hospital, National Relevance and High Specialization Hospital , Genova , Italy
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171
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A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. J Geriatr Oncol 2015; 6:411-7. [DOI: 10.1016/j.jgo.2015.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022]
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172
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Lichtman SM. Polypharmacy: Geriatric Oncology Evaluation Should Become Mainstream. J Clin Oncol 2015; 33:1422-3. [DOI: 10.1200/jco.2014.60.3548] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stuart M. Lichtman
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
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