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Suzuki H, Yamamoto A, Ono K, Yamada Y, Oki Y, Ohira M, Ishikawa A. Is polypharmacy a risk factor for aspiration pneumonia in older adults? A case-control study. Arch Gerontol Geriatr 2024; 122:105363. [PMID: 38367525 DOI: 10.1016/j.archger.2024.105363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/13/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The incidence of aspiration pneumonia and the number of medicines prescribed increase with older age. Many medicines pose a risk for aspiration pneumonia, especially those that decrease swallowing function. Older adults with polypharmacy often receive a combination of these medicines. This study aimed to clarify whether polypharmacy is a risk factor for aspiration pneumonia. METHODS Older adults aged ≥ 65 years receiving oral medicines were included in this case-control study. Patients hospitalized for pneumonia served as the case group, and other age-matched hospitalized patients served as the control group. Patient data were collected retrospectively, and logistic regression analysis was performed using items that showed significant differences in the univariate analysis as explanatory variables. RESULTS Logistic regression analysis revealed that the number of medicines was not a risk factor for aspiration pneumonia; however, it was associated with the Functional Oral Intake Scale score, male sex, body mass index, and number of comorbidities. CONCLUSION Although polypharmacy is often defined only by the number of medicines, it is not a risk factor for aspiration pneumonia. A detailed comparison of prescription medicines between the pneumonia and non-pneumonia groups is necessary.
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Affiliation(s)
- Haruko Suzuki
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan; National Hospital Organization Shinshu Ueda Medical Center, 1-27-21 Midorigaoka, Ueda City, Nagano Prefecture, Japan.
| | - Akio Yamamoto
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Kumiko Ono
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Yoji Yamada
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Yutaro Oki
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Mineko Ohira
- National Hospital Organization Higashi Nagano Hospital, 2-477 Ueno, Nagano City, Nagano Prefecture, Japan
| | - Akira Ishikawa
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
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2
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Oliveira RF, Oliveira AI, Cruz AS, Ribeiro O, Afreixo V, Pimentel F. Polypharmacy and drug interactions in older patients with cancer receiving chemotherapy: associated factors. BMC Geriatr 2024; 24:557. [PMID: 38918696 PMCID: PMC11201315 DOI: 10.1186/s12877-024-05135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Polypharmacy in older adults with cancer receiving chemotherapy leads to increased risks of drug interactions, translating in potential hazardous health outcomes. This study aims to assess the prevalence of polypharmacy, drug-drug interactions (DDIs), and severe-drug interactions (SDIs) in older patients with cancer. Antineoplastic agents (ANAs) involvement and possible risk contexts (comorbidities with cardiac risk, and high-risk medications) were also analysed. METHODS Observational study with older adults (≥ 65 years) diagnosed with cancer, who were treated with antineoplastic agents (ANAs); it was conducted in three hospitals from the north of Portugal. Data collection was obtained using self-reports and medical records. DDIs were identified and classified using Micromedex® software. Descriptive and association analyze statistics were performed. Statistical hypothesis tests with p value less than 0.05 were considered significant. All statistical procedures and analysis were performed with R version 4.1.3. RESULTS We enrolled 552 patients. Polypharmacy prevalence was 88.40%; 76.45% and 56.16% of the patients presented with DDIs and SDIs, respectively. SDIs with ANAs were found in 21.20% of the patients. High-risk medications were associated with a higher risk of polypharmacy, DDIs, and SDIs. Polypharmacy and DDIs were higher in patients with hypertension or diabetes. SDIs were higher in patients with diabetes. CONCLUSION Polypharmacy, potential DDIs and SDIs were highly prevalent in older adults with cancer. A careful review of the medication administered is necessary to decrease it. These findings warrant further research to optimize medication in this population and decrease problems related to medication, which may lead to emergency room visits and hospitalisations, compromising patient safety and/or ongoing treatments.
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Affiliation(s)
- Rita F Oliveira
- University of Aveiro, Aveiro, Portugal.
- ESS, Polytechnic of Porto, Porto, Portugal.
- Center for Health Technology and Services Researchat the Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro (UA), Aveiro, Portugal.
| | - Ana I Oliveira
- REQUIMTE/LAQV, ESS, Polytechnic of Porto, Porto, Portugal
| | | | - Oscar Ribeiro
- Center for Health Technology and Services Researchat the Associate Laboratory RISE - Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro (UA), Aveiro, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro (UA), Aveiro, Portugal
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Schuurman MS, Lemmens VEPP, Portielje JEA, van der Aa MA, Visser O, Dinmohamed AG. The cancer burden in the oldest-old: Increasing numbers and disparities-A nationwide study in the Netherlands, 1990 to 2019. Int J Cancer 2024; 154:261-272. [PMID: 37664984 DOI: 10.1002/ijc.34705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023]
Abstract
Adults aged ≥80 years (the oldest-old) comprise the fastest growing age group in Western populations. Yet little is known about their cancer burden. In this nationwide study, we assessed their trends in incidence, treatment and survival over a 30-year period, and predicted their future cancer incidence. All 2 468 695 incident cancer cases during 1990 to 2019 were selected from the Netherlands Cancer Registry, of whom 386 611 were diagnosed in the oldest-old (16%). The incidence of the oldest-old was predicted until 2032. Net and overall survival (OS) were calculated. Patients were divided into four age groups (<80, 80-84, 85-89 and ≥90 years). The incidence of the oldest-old doubled between 1990 and 2019 and is expected to grow annually with 5% up to 2032. In virtually all cancers the share of oldest-old patients grew, but declined for prostate cancer (25% in 1990-1994 vs 13% in 2015-2019). The proportion of undetermined disease stage increased with age in most cancers. The application of systemic therapy increased, albeit less pronounced in the oldest-old than their younger counterparts (1990 vs 2019: 12%-34%, 3%-15%, 2%-7% and 1%-3% in <80, 80-84, 85-89 and ≥90 years old). Five-year OS of the oldest-old patients increased by 7 percentage points (to 26%) between 1990 to 1994 and 2015 to 2019 compared to 19 percentage points (to 63%) in <80 years old. The oldest-old cancer patients are a rapidly growing group who benefitted less from improvements in cancer treatment than younger patients, reflecting the multiple challenges faced in the care of the oldest-old.
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Affiliation(s)
- Melinda S Schuurman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Maaike A van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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4
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Bandidwattanawong C, Rattanaserikulchai P, Jetsadavanit N. Polypharmacy and potentially-inappropriate medications are prevalent in the elderly cancer patients receiving systemic cancer therapy and they co-relate with adverse outcomes. BMC Geriatr 2023; 23:775. [PMID: 38012569 PMCID: PMC10680314 DOI: 10.1186/s12877-023-04471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Cancer is the disease of the ageing. Most of the elderly cancer patients have pre-existing illnesses requiring complexity of medical care. Excessive medications would lead not only futility, but also result in adverse outcomes especially if such over-prescription is not appropriate. This study was intended to determine the prevalence of polypharmacy (PP) and potentially-inappropriate medications (PIMs) among elderly cancer patients eligible for active cancer care and their associations with hospitalization and mortality. MATERIALS AND METHODS This was a prospective cohort study conducted among the elderly non-hematologic cancer patients (≥ 65 years old) whom a medical oncologist had decided suitable for systemic cancer therapy. Demographic data including age, sex, primary site of cancer, cancer stage at diagnosis, Charlson Comorbidity Index (CCI), numbers and kinds of medications used both prior to and during cancer treatment were recorded. Hospitalizations not related to systemic cancer therapy administration and mortality were prospectively monitored. All of the patients had to be followed at least one year after cancer diagnosis. RESULTS There were 180 eligible participants. Median age in years (IQR) was 68 (65-73). One hundred patients (55.56%) were male and 80 patients (44.44%) were female. Breast (35, 19.44%), lung (31, 17.22%) and colorectal (18, 10%) cancers were the most common diagnoses. Eighty-six patients (47.78%) had metastatic disease at cancer diagnosis. One hundred twenty-two patients (67.78%) had PP (5 or more medications a day) and thirty-six patients (20%) had hyper-PP (10 or more medications a day). One hundred twenty five of the whole cohort (69.4%) had PIMs. Patients with more serious CCI scores were associated with PP and hyper-PP. While patients with primary lung cancer was only the only factor associated with PIMs. When excluding opioids, laxatives and anti-emetics, the most frequently prescribed drugs during cancer treatment, the so-called corrected PP did not associate with worse 1-year survival. Factors correlated with 1-year mortality were more advanced age group (70 years old or more) (OR 2.24; 95% C.I., 1.14-4.41; p = 0.019), primary lung cancer (OR 2.89; 95% C.I., 1.45-5.78; p = 0.003), metastatic disease at cancer diagnosis (OR 4.57; 95% C.I., 1.90-10.97; p = 0.001), and unplanned hospitalizations (OR 3.09; 95% C.I.,1.60-5.99; p = 0.001). While male gender (OR 2.35; 95% C.I., 1.17-4.71; p = 0.016), metastatic stage at cancer diagnosis (OR 2.74; 95% C.I., 1.33-5.66; p = 0.006) and corrected PP (OR 1.90; 95% C.I. 1.01-3.56; p = 0.046) were the significant predictive factors of unplanned hospitalizations. CONCLUSION Among elderly cancer patients suitable for systemic cancer therapy, around two thirds of patients had PP and PIMs. Higher CCI score was the only significant predictor of PP and hyper-PP; while primary lung cancer was the sole independent factor predicting PIMs. PP was associated with unplanned hospitalizations, albeit not the survival.
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Affiliation(s)
- Chanyoot Bandidwattanawong
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand.
| | - Pat Rattanaserikulchai
- Department of Internal Medicine, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
| | - Nontakorn Jetsadavanit
- Department of Internal Medicine, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
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Croize-Pourcelet C, Nouguerede E, Rey D, Daumas A, Gentile G, Villani P, Couderc AL. Geriatric syndromes in a centenarians population. Aging Clin Exp Res 2022; 34:3131-3136. [PMID: 36083575 PMCID: PMC9462066 DOI: 10.1007/s40520-022-02248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
Background Centenarians develop diseases later than younger populations. Aims Assessment of geriatric syndromes in centenarians living in Marseille in 2020. Methods Observational preliminary study describing centenarians living in the Marseille area, being part of the patients base of the general practitioners (GPs). Results Twenty-two centenarians were enrolled, including seventeen women (77.3%). Thirteen centenarians lived in nursing homes (NH) and nine in private housing (PH). All were dependent for daily living activities and 78.9% used walkers to get around. GPs consultations were exclusively home visits (in NH or PH). Centenarians living in NH presented more cognitive impairments, more comorbidities, and fewer hospitalizations during the past year compared to centenarians living in PH. Discussion Although centenarians represent a model of successful aging for society, all were dependent and had at least one geriatric syndrome. Conclusions Maintaining centenarians at home requires technical aids and intervention of several professional caregivers relying on family support.
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Affiliation(s)
- Cécile Croize-Pourcelet
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Emilie Nouguerede
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Aurélie Daumas
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Univ, Marseille, France
| | - Gaetan Gentile
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France.,CNRS, EFS, ADES, Aix-Marseille Univ, Marseille, France
| | - Anne-Laure Couderc
- Internal Medicine, Geriatric and Therapeutic Unit, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France. .,CNRS, EFS, ADES, Aix-Marseille Univ, Marseille, France.
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Alassadi S, Pisani MJ, Wheate NJ. A chemical perspective on the clinical use of platinum-based anticancer drugs. Dalton Trans 2022; 51:10835-10846. [PMID: 35781551 DOI: 10.1039/d2dt01875f] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Platinum drugs have been a mainstay of cancer chemotherapy since the introduction of cisplatin in the 1970s. Since then, carboplatin and oxaliplatin have been approved world-wide and nedaplatin, lobaplatin, heptaplatin, dicycloplatin, and miriplatin have been approved in individual countries. The three main platinum drugs are not used in isolation but are combined in chemotherapy protocols from a range of 28 drugs that include: anthracyclines, alkylating agents, vinca alkaloids, antimetabolites, topoisomerase inhibitors, taxanes, and monoclonal antibodies. Interestingly, they are not yet used in combination with tyrosine kinase inhibitors or proteasome inhibitors. How platinum drugs are formulated for administration to patients is important to minimise aquation during storage and administration. Cisplatin is typically formulated in saline-based solutions while carboplatin and oxaliplatin are formulated in dextrose. Pharmacokinetics are an important factor in both the efficacy and safety of platinum drugs. This includes the quantity of protein-bound drug in blood serum, how fast the drugs are cleared by the body, and how fast the drugs are degraded and deactivated. Attempts to control platinum pharmacokinetics and side effects using rescue agents, macrocycles, and nanoparticles, and through the design of platinum(IV)-based drugs have not yet resulted in clinically successful outcomes. As cancer is predominantly a disease of old age, many cancer patients who are administered a platinum drug may have other medical conditions which means they may also be taking many non-cancer medicines. The co-administration of non-cancer medicines to patients can potentially affect the efficacy of platinum drugs and/or change the severity of their side effects through drug-drug interactions.
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Affiliation(s)
- Shoohb Alassadi
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia.
| | - Michelle J Pisani
- East Hills Boys High School, Lucas Road, Panania, NSW, 2213, Australia
| | - Nial J Wheate
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia.
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Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116896. [PMID: 35682479 PMCID: PMC9180165 DOI: 10.3390/ijerph19116896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65−0.74) for the STOPP criteria and 0.60 (0.52−0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.
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8
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Yekedüz E, Aktaş EG, Köksoy EB, Doğan N, Ürün Y, Utkan G. The prognostic role of polypharmacy in metastatic colorectal cancer patients treated with regorafenib. Future Oncol 2022; 18:1067-1076. [PMID: 35109668 DOI: 10.2217/fon-2021-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate polypharmacy (PP) in patients with metastatic colorectal cancer receiving regorafenib. Methods: Patients with metastatic colorectal cancer receiving regorafenib were included and divided into two categories by their PP status: PP- (<5 regular drug use/day) and PP+ (≥5 regular drug use/day). Results: 80 patients were included. 31 (38.7%) patients had PP. The median number of drugs used was three and seven in PP- and PP+ patients, respectively. Antiemetics (26.5%) and antacids (48.4%) were the most common drugs used by PP- and PP+ patients, respectively. In multivariate analysis, the risk of death was higher in PP+ patients (hazard ratio: 2.1; 95% CI: 1.2-3.7; p = 0.005). Conclusion: PP was an independent prognostic factor for overall survival in patients with metastatic colorectal cancer receiving regorafenib.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Elif Gizem Aktaş
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Elif Berna Köksoy
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Neslihan Doğan
- Medical Oncology Clinic, Prof Dr A İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, 28100, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, 06590, Turkey.,Ankara University Cancer Research Institute, Ankara, 06590, Turkey
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9
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Herrstedt J, Lindberg S, Petersen PC. Prevention of Chemotherapy-Induced Nausea and Vomiting in the Older Patient: Optimizing Outcomes. Drugs Aging 2021; 39:1-21. [PMID: 34882284 PMCID: PMC8654643 DOI: 10.1007/s40266-021-00909-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) are still two of the most feared side effects of cancer therapy. Although major progress in the prophylaxis of CINV has been made during the past 40 years, nausea in particular remains a significant problem. Older patients have a lower risk of CINV than younger patients, but are at a higher risk of severe consequences of dehydration and electrolyte disturbances following emesis. Age-related organ deficiencies, comorbidities, polypharmacy, risk of drug–drug interactions, and lack of compliance all need to be addressed in the older patient with cancer at risk of CINV. Guidelines provide evidence-based recommendations for the prophylaxis of CINV, but none of these guidelines offer specific recommendations for older patients with cancer. This means that the recommendations may lead to overtreatment in some older patients. This review describes the development of antiemetic prophylaxis of CINV focusing on older patients, summarizes recommendations from antiemetic guidelines, describes deficiencies in our knowledge of older patients, summarizes necessary precautions, and suggests some future perspectives for antiemetic research in older patients.
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Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sanne Lindberg
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Peter Clausager Petersen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
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10
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Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12:443-452. [PMID: 33694123 PMCID: PMC8149355 DOI: 10.1007/s41999-021-00479-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. METHODS The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. RESULTS One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. CONCLUSION The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.
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Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Abstract
Cardio-Oncology has blossomed as a new field in cardiovascular medicine, in large part due to new therapies, which may have cardiovascular sequelae. Despite this, anthracyclines still serve as cornerstone therapy for most pediatric cancers, several solid tumors and hematological malignancies. Cardiotoxicity is the main limiting concern with anthracyclines, and this is particularly an issue in patients in extremes of age (both young and old patients). Pediatric hearts are susceptible for cardiotoxicity, while in older patients, concomitant risk factors may contribute to lower threshold for cardiotoxic effects. With increasing patient survival, a significant increase in elderly cancer patients and long-term cardiotoxicity effects of anthracyclines, a better mechanistic understanding of age-dependent processes-that define cardiotoxicity-is needed. This review sheds light on how age affects underlying molecular pathways of anthracycline-associated cardiotoxicity and aims to provide preventive strategies that can be used in clinical practice.
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Affiliation(s)
- Elles M Screever
- Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wouter C Meijers
- Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javid J Moslehi
- Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Turner J, Kantilal K, Kantilal K, Holmes H, Koczwara B. Optimising Medications for Patients With Cancer and Multimorbidity: The Case for Deprescribing. Clin Oncol (R Coll Radiol) 2020; 32:609-617. [DOI: 10.1016/j.clon.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 12/18/2022]
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13
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Polypharmacy as a prognostic factor in older patients with advanced non-small-cell lung cancer treated with anti-PD-1/PD-L1 antibody-based immunotherapy. J Cancer Res Clin Oncol 2020; 146:2659-2668. [PMID: 32462298 DOI: 10.1007/s00432-020-03252-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Polypharmacy is a common problem among older adults. However, its prevalence and impact on the clinical outcomes of anticancer treatment, such as survival and adverse events, in older patients with advanced cancer have not been well investigated. METHODS We retrospectively reviewed data from Japanese patients treated with an immune checkpoint inhibitor (ICI) for advanced or recurrent non-small-cell lung cancer (NSCLC) between 2016 and 2019. RESULTS Among 157 older (aged ≥ 65 years) patients, the prevalence of polypharmacy, defined as ≥ 5 medications, was 59.9% (94/157). The prevalence of potentially inappropriate medication use, according to the screening tool of older people's prescription (STOPP) criteria version 2, was 38.2% (60/157). The median progression-free survival (PFS) in patients with and without polypharmacy was 3.7 and 5.5 months, respectively (P = 0.0017). The median overall survival (OS) in patients with and without polypharmacy was 9.5 and 28.1 months, respectively (P < 0.001). Multivariate analysis revealed marked associations between polypharmacy and OS, but no significant associations between polypharmacy and PFS. Polypharmacy was not associated with immune-related adverse events but was associated with higher rate of unexpected hospitalizations during ICI treatment (59.6% vs. 31.7%, P < 0.001). CONCLUSION Polypharmacy is an independent prognostic factor in older patients with advanced NSCLC treated with ICI. Also, polypharmacy could be utilized as a simple indicator of patients' comorbidities and symptoms or as a predictive marker of unexpected hospitalizations during ICI treatment.
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14
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The influence of polypharmacy, potentially inappropriate medications, and drug interactions on treatment completion and prognosis in older patients with ovarian cancer. J Geriatr Oncol 2020; 11:593-602. [DOI: 10.1016/j.jgo.2019.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/07/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
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15
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Topaloğlu US, Özaslan E. Comorbidity and polypharmacy in patients with breast cancer. Breast Cancer 2020; 27:477-482. [PMID: 31898155 DOI: 10.1007/s12282-019-01040-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer sufferers are aged ≥ 65 years, but research has focused infrequently on elderly patients with the majority of cancer. We aimed not only to determine the frequency of comorbidity and polypharmacy, but also to present the discrepiancies in elderly versus non-elderly patients with breast cancer. METHODS A total of 352 female patients aged over 18 years, 252 non-elderly and 100 elderly, followed-up in the oncology department of a tertiary hospital between January 2016 and September 2019 were retrospectively screened. Demographic data, comorbidity and medications of the patients were recorded hospital data processing system. Polypharmacy was defined as the use of ≥ 5 different medications. RESULTS The most common four chronic diseases in both non-elderly and elderly groups were muscle-joint-bone disease, gastrointestinal diseases, diabetes mellitus and hypertension. The most common four prescribed drugs were NSAID, adjuvant endocrine therapy, PPI, and vitamin D or/and calcium in non-elderly group while those were ACEI-ARB, PPI, NSAID, and diuretics in elderly one. The frequency of polypharmacy was 50% (n = 126) in the non-elderly patients and 74% (n = 74) in the elderly ones. These were considered statistically significant (p < 0.001). The mean number of prescription medication categories reported was 5.02 (SD = 2.90; range 0-14) in non-elderly group whereas those was 6.83 (SD = 3.18; range 0-15) in elderly one (p < 0.001). The mean of ages were 47.9 years (without polypharmacy) and 51.3 years (with polypharmacy) in non-elderly patients while those are, respectively, 70.9 years and 74.7 years in elderly ones. These were considered statistically significant (respectively; p = 0.006, p = 0.009). CONCLUSIONS We first gained to raise awareness in the literature of comorbidity and polypharmacy in patients with breast cancer and to compare between the elderly and non-elderly participants. For the effectiveness of cancer treatment, importance in geriatric population, attention to drug-drug interaction, such studies should be considered during clinical practice.
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Affiliation(s)
| | - Ersin Özaslan
- Department of Medical Oncology, Acıbadem Kayseri Hospital, Kayseri, Turkey
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16
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Li JW, Hsieh HM, Weng SF, Lee IC. Polypharmacy and Utilization of Health Care Services: A Cohort Study of People Aged Over 50 Years in Taiwan. Asia Pac J Public Health 2019; 31:257-266. [PMID: 30803259 DOI: 10.1177/1010539519828077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to understand the changes and correlation in the long-term trends of polypharmacy and the utilization of health care services in a population over the age of 50 years through the use of a national database. A total of 2813 subjects who participated in surveys in 1999, 2003, and 2007 were selected as the samples. Each subject was followed-up for the period of 9 years. From 1999 to 2007, the proportion of mild and severe polypharmacy cases increased from 41.5% (1999) to 51.3% (2003) and 57.1% (2007), respectively. This study found that the more severe the polypharmacy was, the higher the risk of health care service utilization would be. The Generalized Estimating Equation model of multivariate analysis showed that the incidence rate ratio of medical utilization increased with the severity of polypharmacy, as did the use of advanced medical resources (ie, the number of hospitalizations). In particular, the increase in incidence rate ratio was more significant in 3 aspects: (1) number of pharmacy visits; (2) number of emergency room admissions; and (3) number of hospitalizations. The government should establish policies and guidance for the safe use of medicines to ensure reduced risk for older people.
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Affiliation(s)
- Ji-Wen Li
- 1 Kaohsiung Medical University, Kaohsiung
| | | | | | - I-Chen Lee
- 1 Kaohsiung Medical University, Kaohsiung
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17
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Conte C, Bourrel R, Despas F, Lapeyre-Mestre M. Is there overuse of proton pump inhibitors in B-cell non-Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi-Pyrénées region. Fundam Clin Pharmacol 2019; 33:327-338. [PMID: 30625254 DOI: 10.1111/fcp.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/22/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
Abstract
Patients suffering from B-cell non-Hodgkin lymphomas (B-NHL) have an increased likelihood of being exposed to proton pump inhibitors (PPIs), related to several factors which have been reported in the literature. PPIs are among the drugs most likely to be prescribed inappropriately. Consequently, B-NHL patients could be particularly at risk of inappropriate PPI prescription, with potential adverse drug reactions. We aimed to evaluate the incidence of PPIs use and to identify factors associated with PPIs initiation during the active treatment phase of B-NHL. We conducted a new-user cohort study using regional data from the French national health insurance database in the Midi-Pyrénées region (southwestern France). Incident B-NHL patients were selected according to an algorithm of selection, validated with data from a cancer registry. Our study revealed that 48.9% (95% confidence interval [CI]: 45.2-52.6) of patients initiated PPIs during chemotherapy after B-NHL diagnosis. According to information available in the SNDS, recommended indications for PPI prescriptions were identified in 21.1% of cases. Median duration of treatment was 65.3 days (CI: 35-112). Determinants of PPIs initiation were peptic ulcer disease, gastroprotection (appropriate or not) for medications considered at risk (NSAIDs, glucocorticoids and anticoagulants), age, nonfollicular lymphoma, polypharmacy, gastroenterologists' consultations and being hospitalized in a university hospital. Around 50% of patients initiated PPI treatment during the chemotherapy phase with only one-fifth identified as appropriate prescriptions and with long durations of treatment in most cases. Given this background, appropriate PPI prescription should be promoted in B-NHL to avoid potential inappropriate chronic use and related adverse events.
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Affiliation(s)
- Cécile Conte
- UMR1027, INSERM, Université Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Laboratoire de Pharmacologie Médicale et Clinique, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Robert Bourrel
- Caisse Nationale d'Assurance Maladie Midi-Pyrénées, 3 Boulevard Léopold Escande, 31105, Toulouse, France
| | - Fabien Despas
- UMR1027, INSERM, Université Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Laboratoire de Pharmacologie Médicale et Clinique, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,INSERM CIC 1436 Toulouse, Centre d'Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- UMR1027, INSERM, Université Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Laboratoire de Pharmacologie Médicale et Clinique, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,INSERM CIC 1436 Toulouse, Centre d'Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Götze H, Köhler N, Taubenheim S, Lordick F, Mehnert A. Polypharmacy, limited activity, fatigue and insomnia are the most frequent symptoms and impairments in older hematological cancer survivors (70+): Findings from a register-based study on physical and mental health. J Geriatr Oncol 2019; 10:55-59. [DOI: 10.1016/j.jgo.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 01/23/2023]
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19
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Murphy CC, Fullington HM, Alvarez CA, Betts AC, Lee SJC, Haggstrom DA, Halm EA. Polypharmacy and patterns of prescription medication use among cancer survivors. Cancer 2018; 124:2850-2857. [PMID: 29645083 DOI: 10.1002/cncr.31389] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors. METHODS Using data from the Medical Expenditure Panel Survey (MEPS), the authors matched cancer survivors (5216 survivors) with noncancer controls (19,588 controls) by age, sex, and survey year. Polypharmacy was defined as ≥5 unique medications. The authors estimated the percentage of respondents prescribed medications within therapeutic classes and total prescription expenditures. RESULTS A higher percentage of cancer survivors were prescribed ≥5 unique medications (64.0%; 95% confidence interval [95% CI], 62.3%-65.8%) compared with noncancer controls (51.5%; 95% CI, 50.4%-52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher percentage of newly (≤1 year since diagnosis) and previously (>1 years since diagnosis) diagnosed survivors were prescribed medications compared with controls, with large differences observed with regard to central nervous system agents (65.8% [95% CI, 62.3%-69.3%] vs 57.4% [95% CI, 55.3%-59.5%] vs 46.0% [95% CI, 45.0%-46.9%]). Specifically, nearly 10% of survivors were prescribed benzodiazepines and/or opioids compared with approximately 5% of controls. Survivors had more than double the prescription expenditures (median of $1633 vs $784 among controls). Findings persisted across age and comorbidity categories. CONCLUSIONS Cancer survivors were prescribed a higher number of unique medications, including drugs with abuse potential, thereby increasing their risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Cancer 2018;124:2850-2857. © 2018 American Cancer Society.
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Affiliation(s)
- Caitlin C Murphy
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hannah M Fullington
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carlos A Alvarez
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, Texas
| | - Andrea C Betts
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health-Dallas Regional Campus, Dallas, Texas
| | - Simon J Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - David A Haggstrom
- Center for Health Services and Outcomes Research, Indiana University, Indianapolis, Indiana
| | - Ethan A Halm
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17:230. [PMID: 29017448 PMCID: PMC5635569 DOI: 10.1186/s12877-017-0621-2] [Citation(s) in RCA: 1536] [Impact Index Per Article: 219.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. METHODS The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). RESULTS A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. CONCLUSIONS Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
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21
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Hersh LR, Beldowski K, Hajjar ER. Polypharmacy in the Geriatric Oncology Population. Curr Oncol Rep 2017; 19:73. [DOI: 10.1007/s11912-017-0632-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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22
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Zullig LL, Goldstein KM, Bosworth HB. Changes in the Delivery of Veterans Affairs Cancer Care: Ensuring Delivery of Coordinated, Quality Cancer Care in a Time of Uncertainty. J Oncol Pract 2017; 13:709-711. [PMID: 28892409 DOI: 10.1200/jop.2017.021527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Leah L Zullig
- Duke University; and Durham Veterans Affairs Health Care System, Durham, NC
| | - Karen M Goldstein
- Duke University; and Durham Veterans Affairs Health Care System, Durham, NC
| | - Hayden B Bosworth
- Duke University; and Durham Veterans Affairs Health Care System, Durham, NC
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23
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Barbour S, Smit T, Wang X, Powers D, Arora S, Kansra V, Aapro M, Herrstedt J. Integrated safety analysis of rolapitant with coadministered drugs from phase II/III trials: an assessment of CYP2D6 or BCRP inhibition by rolapitant. Ann Oncol 2017; 28:1268-1273. [PMID: 28327932 PMCID: PMC5452074 DOI: 10.1093/annonc/mdx073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rolapitant, a long-acting neurokinin (NK)1 receptor antagonist (RA), has demonstrated efficacy in prevention of chemotherapy-induced nausea and vomiting in patients administered moderately or highly emetogenic chemotherapy. Unlike other NK1 RAs, rolapitant does not inhibit or induce cytochrome P450 (CYP) 3A4, but it does inhibit CYP2D6 and breast cancer resistance protein (BCRP). To analyze potential drug-drug interactions between rolapitant and concomitant medications, this integrated safety analysis of four double-blind, randomized phase II or III studies of rolapitant examined adverse events (AEs) by use versus non-use of drug substrates of CYP2D6 or BCRP. PATIENTS AND METHODS Patients were randomized to receive either 180 mg oral rolapitant or placebo ∼1-2 h before chemotherapy in combination with a 5-hydroxytryptamine type 3 RA and dexamethasone. Data for treatment-emergent AEs (TEAEs) and treatment-emergent serious AEs (TESAEs) during cycle 1 were pooled across the four studies and summarized in the overall population and by concomitant use/non-use of CYP2D6 or BCRP substrate drugs. RESULTS In the integrated safety population, 828 of 1294 patients (64%) in the rolapitant group and 840 of 1301 patients (65%) in the control group experienced at least one TEAE. Frequencies of common TEAEs were similar in the rolapitant and control populations. Overall, 53% of patients received CYP2D6 substrate drugs, none of which had a narrow therapeutic index (like thioridazine or pimozide), and 63% received BCRP substrate drugs. When grouped by concomitant use versus non-use of CYP2D6 or BCRP substrate drugs, TEAEs and TESAEs occurred with similar frequency in the rolapitant and control populations. CONCLUSIONS The results of this study support the safety of rolapitant as part of an antiemetic triple-drug regimen in patients receiving emetogenic chemotherapy, including those administered concomitant medications that are substrates of CYP2D6 or BCRP, such as ondansetron, docetaxel, or irinotecan.
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Affiliation(s)
- S. Barbour
- Department of Pharmacy, Duke University Hospital, Durham, USA
| | - T. Smit
- The Medical Oncology Center of Rosebank, Johannesburg, South Africa
| | | | | | | | | | - M. Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
| | - J. Herrstedt
- Department of Oncology, Odense University Hospital, Odense, Denmark
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van Erning FN, Zanders MM, Kuiper JG, van Herk-Sukel MP, Maas HA, Vingerhoets RW, Zimmerman DD, de Feyter EP, van de Poll ME, Lemmens VE. Drug dispensings among elderly in the year before colon cancer diagnosis versus matched cancer-free controls. J Clin Pharm Ther 2017; 41:538-45. [PMID: 27549909 DOI: 10.1111/jcpt.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/19/2016] [Indexed: 12/12/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The concomitant use of multiple drugs is common among the general population of elderly. The aim of this study was to provide an overview of which drugs are dispensed to elderly in the year before colon cancer diagnosis and to compare this with cancer-free controls. METHODS Data from the Eindhoven Cancer Registry were linked to the PHARMO Database Network. Patients with colon cancer aged ≥70 years were included and matched with controls on gender, year of birth and postal code. Proportions of cases and controls with ≥1 dispensing of each WHO ATC-2-level drug during the total year and during each quarter of the year were calculated and differences between cases and controls tested. RESULTS AND DISCUSSION Proportion of cases with ≥1 drug dispensing was highest for drugs for constipation (cases vs. controls 58% vs. 10%), antithrombotics (42% vs. 33%), drugs for acid-related disorders (35% vs. 22%), antibacterials (34% vs. 24%), agents acting on the renin-angiotensin system (33% vs. 27%), beta-blockers (33% vs. 23%), lipid-modifying agents (29% vs. 22%), diuretics (29% vs. 21%), psycholeptics (25% vs. 18%) and antianaemics (23% vs. 6%). The proportion of cases with ≥1 drug dispensing increased from the first to the last quarter of the year for drugs for constipation (7%-53%), drugs for acid-related disorders (16%-27%), antibacterials (12%-16%), beta-blockers (26%-28%), psycholeptics (15%-19%) and antianaemics (6%-18%). Elevated proportions of cases with ≥1 drug dispensing for several drugs are mostly related to comorbidity, although increasing proportions of cases with ≥1 drug dispensing for certain drugs during the year can be attributed to the incidence of colon cancer. WHAT IS NEW AND CONCLUSION We have provided insight into which drugs are commonly used in the year preceding colon cancer diagnosis. This may trigger general practitioners and medical specialists to further evaluate the patient.
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Affiliation(s)
- F N van Erning
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands.,Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M M Zanders
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands.,Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - J G Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - H A Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - R W Vingerhoets
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - D D Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - E P de Feyter
- Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands.,General Practice Emmers, 's-Hertogenbosch, The Netherlands
| | - M E van de Poll
- Department of Clinical Pharmacy, Máxima Medical Center, Veldhoven, The Netherlands
| | - V E Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands.,Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Aged patients with metastatic castration resistant prostate cancer: Should we treat with chemotherapy? Cancer Treat Rev 2017; 55:173-180. [PMID: 28411479 DOI: 10.1016/j.ctrv.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 12/17/2022]
Abstract
Prostate cancer largely affects aged men and as life expectancy continues to increase, it is likely to be a growing burden requiring an adequate management. Aging is a heterogeneous process, thus, to assess the individual state of health when making decisions is essential. Comprehensive geriatric assessment allows a detailed evaluation of the state of health of a specific subject and can modify the therapeutic decision. It is still not commonly used because it is time consuming. Chemotherapy should be administered equally in aged well-fit patients as in the general population as per the SIOG (International society of geriatric oncology) recommendations for geriatric evaluation and treatment in prostate cancer patients. Chemotherapy with docetaxel or cabazitaxel is expected to have an efficacy and toxicity similar to younger patients and they might be considered treatment options for these patients among others. In vulnerable or frail patients, weekly or biweekly docetaxel regimens are acceptable treatment options.
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26
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Is my older cancer patient on too many medications? J Geriatr Oncol 2017; 8:77-81. [DOI: 10.1016/j.jgo.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/03/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
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Stopsack KH, Greenberg AJ, Mucci LA. Common medications and prostate cancer mortality: a review. World J Urol 2016; 35:875-882. [PMID: 27492013 DOI: 10.1007/s00345-016-1912-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Most prostate cancer patients also have comorbidities that are treated with both prescription and nonprescription medications; furthermore, many use dietary supplements. We assess their association with prognosis after prostate cancer diagnosis, and we discuss methodological challenges and clinical implications. METHODS We reviewed high-quality observational studies investigating the association of commonly used medications and supplements with prostate cancer-specific mortality. RESULTS There is preliminary evidence that statins and metformin use may be associated with lower risk of cancer-specific mortality after prostate cancer diagnosis; conversely, high calcium and multivitamin supplementation may be associated with increased risk. Evidence is inconclusive for nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (aspirin), insulin, antihypertensives such as angiotensin-converting enzyme inhibitors and beta-blockers, digoxin, and warfarin. Common limitations of the internal validity of studies examined include unmeasured confounding and confounding by indication, competing risks, and time-related biases such as immortal time bias. The majority of studies focused on Caucasian men with specific comorbidities, while heterogeneity among patients and tumors was mostly not assessed. CONCLUSIONS Commonly prescribed medications and over-the-counter supplements may influence prognosis among prostate cancer patients. Further well-designed pharmacoepidemiologic studies and randomized controlled trials of selected medications in appropriate patient groups are necessary before these drugs can bear new indications for prostate cancer treatment. We discuss considerations when deciding about use of these drugs in clinical practice at the present time.
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Affiliation(s)
- Konrad H Stopsack
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Winther SB, Jørgensen TL, Pfeiffer P, Qvortrup C. Can we predict toxicity and efficacy in older patients with cancer? Older patients with colorectal cancer as an example. ESMO Open 2016; 1:e000021. [PMID: 27843604 PMCID: PMC5070237 DOI: 10.1136/esmoopen-2015-000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/29/2022] Open
Abstract
Colorectal cancer is a disease of the elderly. As older and frail patients are under-represented in clinical trials, most of the evidence available on treatment of older metastatic colorectal patients with cancer originates from pooled analyses of the older patients included in large prospective clinical trials and from community-based studies. The aging process is highly individual and cannot be based on the chronological age alone. It is characterised by a decline in organ function with an increased risk of comorbidity and polypharmacy. These issues can result in an increased susceptibility to the complications of both the disease and treatment. Therefore, evaluation of performance status and the chronological age alone is not sufficient, and additionally assessment must be included in the treatment decision process. In the present review, we will focus on clinical aspects of treating older and frail metastatic colorectal patients with cancer, but also on the present knowledge on how to select and tailor therapy for this particular group of patients. TRIAL REGISTRATION NUMBER EudraCT 2014-000394-39, pre-results.
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Affiliation(s)
- Stine Braendegaard Winther
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Qvortrup
- Department of Oncology, Odense University Hospital, Odense, Denmark
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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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Use of tricyclic antidepressants and risk of glioma: a nationwide case-control study. Br J Cancer 2016; 114:1265-8. [PMID: 27115466 PMCID: PMC4891498 DOI: 10.1038/bjc.2016.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 01/13/2023] Open
Abstract
Background: A protective effect of tricyclic antidepressants (TCAs) against gliomas has been suggested by a small number of studies. We investigated this putative association in a nationwide setting. Methods: Using a case–control design, we identified all patients with histologically verified glioma (cases) in Denmark between 2000 and 2012 and matched these 1 : 20 to population controls. Conditional logistic regression was used to estimate adjusted odds ratios (ORs) for glioma associated with long-term (⩾3 years) use of TCAs. Similar analyses were performed for selective serotonin reuptake inhibitors (SSRIs). Results: We identified 3767 glioma cases and 75 340 population controls. Long-term use of TCAs was inversely associated with risk of glioma (OR 0.72, 95% CI: 0.41–1.25). Long-term SSRI use was not associated with glioma risk (OR 0.93, 95% CI: 0.75–1.16). Conclusions: Our study indicated that long-term use of TCAs may be associated with a reduced risk of glioma, however, the statistical precision was limited. A similar pattern was not observed for use of SSRIs.
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Long-term use of lithium and risk of colorectal adenocarcinoma: a nationwide case-control study. Br J Cancer 2016; 114:571-5. [PMID: 26867160 PMCID: PMC4782204 DOI: 10.1038/bjc.2016.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/18/2015] [Accepted: 12/26/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Lithium accumulates in the colon and inhibits the enzyme GSK-3β that possesses anti-carcinogenic effects. We therefore examined the association between lithium use and colorectal cancer risk in a nationwide study. Methods: We used the Danish Cancer Registry to identify all patients diagnosed with incident colorectal adenocarcinoma during 2000–2012 (n=36 248). Using a matched case–control approach, we estimated the association between long-term use (⩾5 years) of lithium and risk of colorectal adenocarcinoma using conditional logistic regression. Results: Long-term use of lithium was similar among cases (0.22%) and controls (0.20%), yielding an odds ratio of 1.13 (95% confidence interval (CI), 0.89–1.43) for colorectal adenocarcinoma. Dose–response, subgroup and other subanalyses returned neutral associations. However, ORs differed for colorectal subsites (proximal colon: 1.01 (95% CI, 0.66–1.55; distal colon: 1.52 (95% CI, 1.05–2.20); and rectum: 0.80 (95% CI, 0.50–1.30). Conclusions: Lithium use was not associated with an overall increased risk of colorectal adenocarcinoma. The variation by subsite warrants further investigation.
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Ewertz M, Christensen K, Engholm G, Kejs AMT, Lund L, Matzen LE, Pfeiffer P, Storm HH, Herrstedt J. Trends in cancer in the elderly population in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:1-6. [PMID: 26781233 DOI: 10.3109/0284186x.2015.1114678] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Age is the strongest risk factor for developing cancer. The aim of the present analysis is to give an overview of the trends in cancer incidence, mortality, prevalence, and relative survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. MATERIAL AND METHODS Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries. The Danish data originate from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS Incidence and mortality rates of all sites, but non-melanoma skin cancer, were higher and relative survival was lower among persons aged 70 years or more than those aged less than 70 years. The age distribution (age group-specific percentages of total number of incident cases) remained constant over time while the percentage of persons dying from cancer decreased with time up to the age of 79 years but increased for those aged 80 years or more, in whom about a third of all cancer deaths occurred in 2012. In 2003-2007, the five-year relative survival was 48% for men aged 70-79 years, 38% for men aged 80-89 years, and 29% for men aged 90 years or more and the corresponding figures for women were 46%, 39%, and 36%, respectively. There was a substantial increase in the number of prevalent cancer cases aged 70 years or older, especially among those aged 90 years or more. CONCLUSION An increase in elderly cancer patients is expected over the coming 20 years due to an increasing elderly population. Healthcare providers need to focus on developing specific strategies for treatment of elderly cancer patients in the future.
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Affiliation(s)
- Marianne Ewertz
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Kaare Christensen
- b The Danish Aging Research Center, Department of Epidemiology, Biostatistics and Biodemography , Institute of Public Health, University of Southern Denmark , Odense , Denmark
- c Department of Clinical Genetics , Odense University Hospital, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital , Odense , Denmark
| | - Gerda Engholm
- d Department of Documentation & Quality , Danish Cancer Society , Copenhagen , Denmark
| | - Anne Mette T Kejs
- d Department of Documentation & Quality , Danish Cancer Society , Copenhagen , Denmark
| | - Lars Lund
- e Department of Urology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Lars E Matzen
- f Geriatric Department , Odense University Hospital , Odense , Denmark
| | - Per Pfeiffer
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Hans H Storm
- d Department of Documentation & Quality , Danish Cancer Society , Copenhagen , Denmark
| | - Jørn Herrstedt
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
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Ocias LF, Larsen TS, Vestergaard H, Friis LS, Abildgaard N, Frederiksen H. Trends in hematological cancer in the elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:98-107. [PMID: 26783877 DOI: 10.3109/0284186x.2015.1115124] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of hematological malignancies is expected to increase as the Danish population ages within the next few decades. Despite this, data on the course of hematological cancers among the oldest patients are sparse with many intervention studies focusing on younger age groups. The aim of this study is to present Danish incidence and mortality rates among older patients with non-Hodgkin lymphomas (NHL), multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and acute myeloid leukemia (AML). MATERIAL AND METHODS Nationwide population-based study presenting the incidence, prevalence and mortality rates of NHL, MM, and AML with a focus on the elderly population in Denmark during the last few decades. Data were drawn from the NORDCAN database. RESULTS Incidence rates of NHL, MM, CLL and AML were 10-50 times higher among the population aged 70 years or more than among the younger population. An increasing incidence with stable or decreased mortality rates was seen mainly among elderly patients with NHL during the last few decades, leading to increased survival and a greater prevalence of patients with NHL. Increased relative survival and prevalence could also be seen among elderly patients with MM and CLL, while the trends of the incidence rates were inconclusive for these diseases. Survival among patients with AML improved most notably in those aged below 70 years leading to an increased prevalence of AML patients predominantly in this age group. CONCLUSION Improvements in diagnostics and treatment have led to increased survival and therefore prevalence of elderly patients with NHL, MM, CLL and AML during the past decades.
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Affiliation(s)
- Lukas F Ocias
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Thomas S Larsen
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Hanne Vestergaard
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Lone S Friis
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Niels Abildgaard
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Henrik Frederiksen
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
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Pottegård A, Clark P, Friis S, Hallas J, Lund L. Long-term Use of Statins and Risk of Renal Cell Carcinoma: A Population-based Case-Control Study. Eur Urol 2015; 69:877-82. [PMID: 26603781 DOI: 10.1016/j.eururo.2015.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/06/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Use of statins has been suggested to protect against renal cell carcinoma (RCC); however, studies have typically been underpowered, and the results are conflicting. OBJECTIVE To determine whether the use of statins is associated with a reduced risk of RCC using high-quality registry data. DESIGN, SETTING, AND PARTICIPANTS We conducted a nationwide case-control study based on all histologically verified cases of RCC in Denmark between 2002 and 2012 (n=4606) matched 1:10 to cancer-free controls. Data on drug use, comorbidity, and educational level were obtained from Danish nationwide prescription, patient, and demographic registries. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Odds ratios (ORs) and 95% confidence intervals (CIs) for RCC associated with long-term use (≥5 yr) of statins were estimated using conditional logistic regression, adjusting for potential confounders. RESULTS AND LIMITATIONS The adjusted OR for RCC associated with long-term use of statins was 1.06 (95% CI, 0.91-1.23). Analyses stratified by duration of statin use, type of statin, and patient characteristics all yielded ORs close to unity, except for a slightly increased OR for RCC associated with long-term statin use among women (OR: 1.25; 95% CI, 0.96-1.62). The main limitation of our study was lack of information on lifestyle factors, notably obesity, which may have biased the risk estimates upward. CONCLUSIONS Our study does not support an important chemopreventive effect of long-term statin use against RCC. The marginally increased and statistically insignificant risk estimates can readily be interpreted as a null finding, considering the lack of control for obesity and other lifestyle risk factors. PATIENT SUMMARY Previous studies have shown that the use of cholesterol-lowering drugs (statins) may protect against renal cancer. In a large study including all Danish renal cancers during an 11-yr period, we found no evidence of such an effect.
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Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
| | - Peter Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen Ø, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Lars Lund
- Clinical Institute, University of Southern Denmark, Odense C, Denmark; Department of Urology, Odense University Hospital, Odense C, Denmark
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Turner JP, Jamsen KM, Shakib S, Singhal N, Prowse R, Bell JS. Polypharmacy cut-points in older people with cancer: how many medications are too many? Support Care Cancer 2015; 24:1831-40. [DOI: 10.1007/s00520-015-2970-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/28/2015] [Indexed: 01/08/2023]
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Friis S, Riis AH, Erichsen R, Baron JA, Sørensen HT. Low-Dose Aspirin or Nonsteroidal Anti-inflammatory Drug Use and Colorectal Cancer Risk: A Population-Based, Case-Control Study. Ann Intern Med 2015; 163:347-55. [PMID: 26302241 DOI: 10.7326/m15-0039] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A recent comprehensive review concluded that additional research is needed to determine the optimal use of aspirin for cancer prevention. OBJECTIVE To assess associations between the use of low-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) and colorectal cancer risk. DESIGN Population-based, case-control study. SETTING Northern Denmark. PATIENTS Patients with first-time colorectal cancer in northern Denmark between 1994 and 2011. Population control participants were selected by risk set sampling. MEASUREMENTS Data on drug use, comorbid conditions, and history of colonoscopy were obtained from prescription and patient registries. Use of low-dose aspirin (75 to 150 mg) and nonaspirin NSAIDs was defined according to type, estimated dose, duration, and consistency of use. RESULTS Among 10 280 case patients and 102 800 control participants, the adjusted odds ratios (ORs) for colorectal cancer associated with ever use (≥2 prescriptions) of low-dose aspirin and nonaspirin NSAIDs were 1.03 (95% CI, 0.98 to 1.09) and 0.94 (CI, 0.90 to 0.98), respectively. Continuous long-term use (≥5 years) of low-dose aspirin was associated with a 27% reduction in colorectal cancer risk (OR, 0.73 [CI, 0.54 to 0.99]), whereas the overall OR for cumulative long-term use (continuous or noncontinuous) was close to unity. Nonaspirin NSAID use was associated with a substantial reduction in colorectal cancer risk, particularly for long-term, high-intensity use (average defined daily dose ≥0.3) of agents with high cyclooxygenase-2 selectivity (OR, 0.57 [CI, 0.44 to 0.74]). LIMITATIONS Data were unavailable on over-the-counter purchases of high-dose aspirin and low-dose ibuprofen or NSAID dosing schedules, there were several comparisons, and the authors were unable to adjust for confounding by some risk factors. CONCLUSION Long-term, continuous use of low-dose aspirin and long-term use of nonaspirin NSAIDs were associated with reduced colorectal cancer risk. Persons who continuously used low-dose aspirin comprised only a small proportion of the low-dose aspirin users. PRIMARY FUNDING SOURCE Danish Cancer Society, Aarhus University Research Foundation.
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Affiliation(s)
- Søren Friis
- From Danish Cancer Society Research Center, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; and University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anders H. Riis
- From Danish Cancer Society Research Center, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; and University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rune Erichsen
- From Danish Cancer Society Research Center, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; and University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John A. Baron
- From Danish Cancer Society Research Center, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; and University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Henrik T. Sørensen
- From Danish Cancer Society Research Center, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark; and University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Yeoh TT, Tay XY, Si P, Chew L. Drug-related problems in elderly patients with cancer receiving outpatient chemotherapy. J Geriatr Oncol 2015; 6:280-7. [DOI: 10.1016/j.jgo.2015.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/30/2015] [Accepted: 05/26/2015] [Indexed: 01/23/2023]
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LeBlanc TW, McNeil MJ, Kamal AH, Currow DC, Abernethy AP. Polypharmacy in patients with advanced cancer and the role of medication discontinuation. Lancet Oncol 2015; 16:e333-41. [DOI: 10.1016/s1470-2045(15)00080-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pottegård A, Hallas J, Jensen BL, Madsen K, Friis S. Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers. J Am Soc Nephrol 2015; 27:249-55. [PMID: 25941353 DOI: 10.1681/asn.2015010061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/09/2015] [Indexed: 01/20/2023] Open
Abstract
Lithium induces proliferation in the epithelium of renal collecting ducts. A recent small-scale cohort study reported a strong association between use of lithium and increased risk of renal neoplasia. We therefore conducted a large-scale pharmacoepidemiologic study of the association between long-term use of lithium and risk of upper urinary tract cancer, including renal cell cancer and cancers of the renal pelvis or ureter. We identified all histologically verified upper urinary tract cancer cases in Denmark between 2000 and 2012 from the Danish Cancer Registry. A total of 6477 cases were matched by age and sex to 259,080 cancer-free controls. Data on lithium use from 1995 to 2012 were obtained from the Danish Prescription Registry. We estimated the association between long-term use of lithium (≥5 years) and risk of upper urinary tract cancer using conditional logistic regression with adjustment for potential confounders. Long-term use of lithium was observed among 0.22% of cases and 0.17% of controls. This yielded an overall nonsignificant adjusted odds ratio (OR) of 1.3 (95% confidence interval [95% CI], 0.8-2.2) for upper urinary tract cancer associated with long-term use of lithium. Analyses stratified by stage and subtype of upper urinary tract cancer revealed slight but nonsignificant increases in the ORs for localized disease (OR, 1.6; 95% CI, 0.8-3.0) and for renal pelvis/ureter cancers (OR, 1.7; 95% CI, 0.5-5.4). In conclusion, in our nationwide case-control study, use of lithium was not associated with an increased risk of upper urinary tract cancer.
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Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark;
| | - Jesper Hallas
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Madsen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark; Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
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Brygger L, Herrstedt J. 5-Hydroxytryptamine3receptor antagonists and cardiac side effects. Expert Opin Drug Saf 2014; 13:1407-22. [DOI: 10.1517/14740338.2014.954546] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Baandrup L, Friis S, Dehlendorff C, Andersen KK, Olsen JH, Kjaer SK. Prescription Use of Paracetamol and Risk for Ovarian Cancer in Denmark. ACTA ACUST UNITED AC 2014; 106:dju111. [DOI: 10.1093/jnci/dju111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy. J Geriatr Oncol 2014; 5:307-14. [PMID: 24821377 DOI: 10.1016/j.jgo.2014.04.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/28/2014] [Accepted: 04/21/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Increased risk of drug interactions due to polypharmacy and aging-related changes in physiology among older patients with cancer is further augmented during chemotherapy. No previous studies examined potential drug interactions (PDIs) from polypharmacy and their association with chemotherapy tolerance in older patients with cancer. METHODS This study is a retrospective medical chart review of 244 patients aged 70+ years who received chemotherapy for solid or hematological malignancies. PDI among all drugs, supplements, and herbals taken with the first chemotherapy cycle were screened for using the Drug Interaction Facts software, which classifies PDIs into five levels of clinical significance with level 1 being the highest. Descriptive and correlative statistics were used to describe rates of PDI. The association between PDI and severe chemotoxicity was tested with logistic regressions adjusted for baseline covariates. RESULTS A total of 769 PDIs were identified in 75.4% patients. Of the 82 level 1 PDIs identified among these, 32 PDIs involved chemotherapeutics. A large proportion of the identified PDIs were of minor clinical significance. The risk of severe non-hematological toxicity almost doubled with each level 1 PDI (OR=1.94, 95% CI: 1.22-3.09), and tripled with each level 1 PDI involving chemotherapeutics (OR=3.08, 95% CI: 1.33-7.12). No association between PDI and hematological toxicity was found. CONCLUSIONS In this convenience sample of older patients with cancer receiving chemotherapy we found notable rates of PDI and a substantial adjusted impact of PDI on risk of non-hematological toxicity. These findings warrant further research to optimize chemotherapy outcomes.
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Turner JP, Shakib S, Singhal N, Hogan-Doran J, Prowse R, Johns S, Bell JS. Prevalence and factors associated with polypharmacy in older people with cancer. Support Care Cancer 2014; 22:1727-34. [PMID: 24584682 DOI: 10.1007/s00520-014-2171-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/10/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE Polypharmacy has been associated with drug-drug interactions, adverse drug events, hospitalisation and increased mortality. The purpose of this study was to investigate the prevalence and factors associated with polypharmacy in older people with cancer. PATIENTS AND METHODS Patients aged≥70 years (n=385) presenting to the medical oncology outpatient clinic at Royal Adelaide Hospital between January 2009 and July 2010 completed a structured data collection instrument. The instrument included domains related to medications, diagnoses, instrumental activities of daily living (IADLs), Karnofsky Performance Scale (KPS), physical function (SF-36), pain (ten-point visual analogue scale, VAS), weight loss (patient self-reported over previous 6 months), exhaustion (CES-D) and distress (ten-point VAS). Frailty was computed using Fried's frailty phenotype. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between polypharmacy (defined as five or more self-reported daily medications) and clinical parameters. RESULTS Polypharmacy was present in 57% (n=221) of patients. When adjusting for age, gender and Charlson Comorbidity Index (CCI), polypharmacy was associated with being pre-frail (OR=2.35, 95%CI=1.43-3.86) and frail (OR=4.48, 95%CI=1.90-10.54) compared to being robust. When adjusting for age, gender, exhaustion, KPS, IADLs, pain and distress, polypharmacy was associated with higher CCI scores (OR=1.58, 95%CI=1.29-1.94) and poorer physical function (OR=1.13, 95%CI=1.06-1.20). CONCLUSIONS Polypharmacy is highly prevalent in older people with cancer and associated with impaired physical function and being pre-frail and frail compared to being robust. Research is needed to identify strategies to minimize patients' medication regimens.
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Affiliation(s)
- Justin P Turner
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia,
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Pottegård A, Friis S, Andersen M, Hallas J. Use of benzodiazepines or benzodiazepine related drugs and the risk of cancer: a population-based case-control study. Br J Clin Pharmacol 2013; 75:1356-64. [PMID: 23043261 DOI: 10.1111/bcp.12001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 09/30/2012] [Indexed: 11/28/2022] Open
Abstract
AIM Studies of the carcinogenic potential of benzodiazepines and related drugs (BZRD) have been equivocal. A recent study reported a 35% excess cancer risk among users of hypnotics, including benzodiazepines. METHOD Using Danish nationwide registers, we conducted a matched case-control study of the association between BZRD and cancer risk. During 1 January 2002 and 31 December 2009, we identified 152 510 cases with a first time cancer who were matched (1:8) by age and gender to 1,220,317 cancer-free controls. A new-user design was applied by excluding all subjects who had used anxiolytics, hypnotics or sedatives during the first 2 years of available prescription data (1995-6). Odds ratios (ORs) with 95% confidence intervals (CI) were estimated using conditional logistic regression, adjusting for potential confounders. In the primary analysis, long term use of BZRD was defined by a cumulative amount of ≥500 defined daily doses of BZRD within a period of 1 to 5 years prior to the index date. RESULTS The adjusted OR for cancer associated with BZRD use was 1.09 (95% CI 1.04, 1.14). ORs were close to unity for most cancer sites, except stomach 1.40 (95% CI 1.05, 1.88), oesophagus 1.43 (95% CI 1.01, 2.02), liver 1.81 (95% CI 1.18, 2.80), lung 1.38 (95% CI 1.23, 1.54), pancreas 1.35 (95% CI 1.02, 1.79) and kidney 1.39 (95% CI 1.01, 1.91). For tobacco-related cancers, the OR was 1.15 (95% CI 1.09, 1.22) and for the remaining cancer sites 1.01 (95% CI 0.94, 1.08). Sub-group analyses revealed only small differences between different levels of exposure or different patient subgroups. CONCLUSION BZRD use was not associated with an overall increase in cancer risk, except for what is likely explained by minor lifestyle confounding, e.g. smoking.
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Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, DK-5000, Odense C, Denmark.
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Balducci L, Goetz-Parten D, Steinman MA. Polypharmacy and the management of the older cancer patient. Ann Oncol 2013; 24 Suppl 7:vii36-40. [PMID: 24001761 PMCID: PMC6278993 DOI: 10.1093/annonc/mdt266] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aging is associated with polymorbidity and polypharmacy. In the absence of a consensual definition, polypharmacy has been defined according to the number of drugs that an individual takes or to the presence of the risk of at least one severe drug interaction. In older cancer patients, polypharmacy is at least as common as it is in individuals of the same age without cancer. The management of cancer itself may result in the addition of more medications to counteract the adverse effects of antineoplastic treatment. Polypharmacy may be necessary to control the multiple health conditions of the older person, but it may represent a risk factor for more complications from antineoplastic therapy, and it may affect the outcome of cancer treatment. Polypharmacy is also associated with increased cost. The criteria proposed for the management of polypharmacy include the assessment that all medical conditions are properly treated, the avoidance of drug interactions, and of drugs that may compromise the outcome of antineoplastic treatment and the choice of drugs with the lowest risk of complications in older individuals.
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Affiliation(s)
- L Balducci
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine,12902 Magnolia Drive,Tampa, FL 33612, USA.
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Abstract
BACKGROUND Aims of this study were to describe the prevalence of comorbidity in newly diagnosed elderly cancer cases compared with the background population and to describe its influence on overall and cancer mortality. METHODS Population-based study of all 70+ year-olds in a Danish province diagnosed with breast, lung, colorectal, prostate, or ovarian cancer from 1 January 1996 to 31 December 2006. Comorbidity was measured according to Charlson's comorbidity index (CCI). Prevalence of comorbidity in newly diagnosed cancer patients was compared with a control group by conditional logistic regression, and influence of comorbidity on mortality was analysed by Cox proportional hazards method. RESULTS A total of 6325 incident cancer cases were identified. Elderly lung and colorectal cancer patients had significantly more comorbidity than the background population. Severe comorbidity was associated with higher overall mortality in the lung, colorectal, and prostate cancer patients, hazard ratios 1.51 (95% CI 1.24-1.83), 1.41 (95% CI 1.14-1.73), and 2.14 (95% CI 1.65-2.77), respectively. Comorbidity did not affect cancer-specific mortality in general. CONCLUSION Colorectal and lung cancer was associated with increased comorbidity burden in the elderly compared with the background population. Comorbidity was associated with increased overall mortality in elderly cancer patients but not consistently with cancer-specific mortality.
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