Photo: Wilmot Cancer Institute
Here's a scenario so common that it applies to nearly 92 percent of older adults with cancer: An individual comes in for treatment and reports taking several medications that might include a drug for high blood pressure or heart disease, an antidepressant, and something for diabetes. The person may also take frequent doses of Advil, over-the-counter pills to relieve heartburn or reflux, antihistamines, vitamins, and minerals. But, patients may not report these as often to the medical team.
This soupy concoction defines "polypharmacy," the concurrent use of multiple medications — which can lead to harmful drug interactions, which is especially dangerous for cancer patients about to undergo therapy.
Even for individuals who do not have cancer, multiple medication use is fraught with risks and tricky to navigate because of the emotions involved, said Erika Ramsdale, M.D., a Wilmot Cancer Institute oncologist at the University of Rochester Medical Center, geriatrics specialist, and data scientist who led a recent study on polypharmacy published in The Oncologist journal. The data is also being presented at the American Society of Clinical Oncology (ASCO) annual meeting 2022 in June.
"As doctors, we tell people to take medications but we don't always do a great job of following up," she said. "From the patient perspective, if it's determined that a medication is no longer needed, it's hard to stop taking it. There's a sense of, 'What will happen if I stop?' or 'Are you giving up on me?' A lot of uncertainty and emotions are tied up in this issue."
The study suggests that the more drugs and supplements a person takes, the higher the risk of inappropriate use and serious drug interactions.
Investigators analyzed medication use in a nationwide sample of 718 adults with a mean age of 77 and advanced cancer plus comorbidities. They were looking for potentially inappropriate medications that have risks higher than benefits (known as PIMS), drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). The consequences of drug interactions include falls, functional decline, and death.
Among the 718 patients, 70 percent were at risk of drug-drug interactions and 67 percent were taking at least one drug that was potentially inappropriate. The study suggests opportunities for education and problem-solving, such as "deprescribing" some drugs after careful evaluation of risks and benefits.