title: Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment.
abstract: OBJECTIVE
  To evaluate the prevalence of polypharmacy and potentially inappropriate medication (PIM) use and the association between these and chemotherapy-related adverse events in older adults with cancer undergoing chemotherapy.
  
  
  METHODS
  Secondary analysis of prospectively collected data.
  
  
  METHODS
  Outpatient oncology clinics in seven academic medical centers.
  
  
  METHODS
  Adults aged 65 and older with cancer undergoing chemotherapy.
  
  
  METHODS
  Measures included number of daily medications (polypharmacy); PIM use based on three indices (Beers, Zhan, and Drugs to Avoid in the Elderly criteria), and use of six "high risk" medication classes for adverse drug events (anticoagulants, antiplatelet agents, opioids, insulin, oral hypoglycemics, antiarrhythmics). Using multivariate logistic regression, the relations were evaluated between these criteria and Grade 3 to 5 chemotherapy-related toxicity and between these criteria and hospitalization during chemotherapy.
  
  
  RESULTS
  Participants (N=500; mean age 73, 61% Stage IV disease) took a mean of 5±4 daily medications (range 0-23). PIM use was common (up to 29% according to Beers criteria). No association was found between number of daily medications (reference 0-3 medications) and toxicity (4-9 medications, odds ratio (OR)=1.34, 95% confidence interval (CI)=0.92-1.97; ≥10 medications, OR=0.82, 95% CI=0.45-1.49) or hospitalization (≥4 medications, OR=1.34, 95% CI=0.82-2.18, P=.24). There was also no association between PIM use and toxicity (P=.93) or hospitalization (P=.98). No medication class was associated with either outcome.
  
  
  CONCLUSIONS
  Polypharmacy and PIM use were common but were not associated with chemotherapy-related toxicity or hospitalization in older adults with cancer.
authors.affiliation: Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Maggiore
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.forename: Tao
authors.initials: T
authors.lastname: Feng
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lichtman
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.forename: Rupal
authors.initials: R
authors.lastname: Ramani
authors.forename: Vani
authors.initials: V
authors.lastname: Katheria
authors.forename: Laura
authors.initials: L
authors.lastname: Zavala
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D019338:Polypharmacy; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: cancer; chemotherapy; elderly; polypharmacy; toxicity