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Observational Study
. 2022 Aug 30;22(1):716.
doi: 10.1186/s12877-022-03390-z.

Medication risks in older patients (70 +) with cancer and their association with therapy-related toxicity

Imke Ortland  1 , Monique Mendel Ott  1 , Michael Kowar  2 , Christoph Sippel  3 , Yon-Dschun Ko #  3 , Andreas H Jacobs #  2 , Ulrich Jaehde #  4
Affiliations
Observational Study

Medication risks in older patients (70 +) with cancer and their association with therapy-related toxicity

Imke Ortland et al. BMC Geriatr. .

Abstract

Background: To evaluate medication-related risks in older patients with cancer and their association with severe toxicity during antineoplastic therapy.

Methods: This is a secondary analysis of two prospective, single-center observational studies which included patients ≥ 70 years with cancer. The patients' medication lists were investigated regarding possible risks: polymedication (defined as the use of ≥ 5 drugs), potentially inappropriate medication (PIM), and relevant potential drug-drug interactions (rPDDI). The risks were analyzed before and after start of cancer therapy. Severe toxicity during antineoplastic therapy was captured from medical records according to the Common Terminology Criteria for Adverse Events (CTCAE). The association between grade ≥ 3 toxicity and medication risks was evaluated by univariate as well as multivariate regression adjusted by ECOG and age.

Results: The study cohort comprised 136 patients (50% female, mean age 77 years, 42% hematological malignancies). Before the start of cancer therapy, patients took on average 5 drugs as long-term medication and 52% of patients were exposed to polymedication. More than half of patients used at least one PIM. Approximately one third of patients exhibited rPDDI. The prevalence of medication risks increased after start of cancer therapy. rPDDI were significantly associated with severe overall toxicity (OR, 5.07; p = 0.036; 95% Confidence Interval (CI) 1.11-23.14; toxicity in patients with rPDDI 94.1% (32/34) vs 75.9% (60/79) in patients without rPDDI) and hematological toxicity (OR, 3.95; p = 0.010; 95% CI 1.38-11.29; hematological toxicity in patients with rPDDI 85.3% (29/34) vs 59.5% (47/79) in patients without rPDDI). In the multivariate analysis adjusted by ECOG and age, only the association for rPDDI with hematological toxicity remained statistically significant (OR, 4.51; p = 0.007; 95% CI 1.52-13.38). These findings should be further investigated in larger studies.

Conclusion: Medication risks are common in older patients with cancer and might be associated with toxicity. This raises the need for tailored interventions to ensure medication safety in this patient cohort.

Keywords: Drug-drug interactions; Older patients with cancer; Onco-geriatrics; Polymedication; Potentially inappropriate medication; Toxicity.

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Conflict of interest statement

IO, MK declare that they have no competing interests. UJ, AHJ, YDK report grants from the Herbert-Worch foundation during the conduct of the studies. Upon submission of this manuscript, MMO was employed at Mitsubishi Tanabe Pharma GmbH, however this was not the case during her main contribution to this study. CS reports honoraria from Gilhead outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow chart of patient inclusion for medication risk analysis
See this image and copyright information in PMC

References

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