In a study published by Grace Lu-Yao, PhD, and colleagues in the Journal of Geriatric Oncology, researchers found hospitalization rates can increase by as much as 114% in patients with breast, prostate, and lung cancers when those patients have taken 15 or more medications prior to chemotherapy treatment. Polypharmacy—defined as taking five or more concurrent medications—is common among older patients with cancer and associated with increased frailty, morbidity, and mortality.
Grace Lu-Yao, PhD
“The comprehensive real-world data we looked at gives us a sense of what’s happening today and offers clues on how we could reduce hospitalizations in older patients [with cancer],” said senior author Dr. Lu-Yao, Associate Director of Population Science at the Sidney Kimmel Cancer Center (SKCC)–Jefferson Health.
“The older patients get, typically the more complex their care becomes—this is especially true when cancer treatment is combined with preexisting conditions,” added study coauthor Andrew Chapman, DO, Co-Director of the Senior Adult Oncology Center and Chief of Cancer Services at SKCC.
Study Details
The researchers identified a pool of 13,959 patients with prostate, lung, and breast cancers from a national database of Medicare patients. Patients included were aged 65 years or older, had been diagnosed with their cancer from 1991 to 2013, and received intravenous chemotherapy between 2011 and 2014.
Researchers grouped patients by the number of treatments they were on for the 6 months prior to starting chemotherapy. “By looking at hospitalization rates in the 6 months leading up to the start of chemotherapy, we were able to get a baseline … data point for these patients, that we could compare against the rates of hospitalization after chemotherapy,” said Dr. Lu-Yao.
Patients with lung cancer were taking a median of 11 medications; patient with prostate cancer patients were taking a median of 10; and those with breast cancer were on a median of 6 therapies.
KEY POINTS
- Patients with lung cancer were taking a median of 11 medications; patient with prostate cancer patients were taking a median of 10; and those with breast cancer were on a median of 6 therapies.
- Patients with prostate cancer taking between 5 and 9 medications had a 42% higher rate of hospitalization, those taking 10 to 14 medications had a 75% increase, and those taking over 15 medications prior to chemotherapy had a 114% higher rate compared to patients taking fewer than 5 medicines.
- The researchers saw similar increases in patients with both breast and lung cancers as well.
Results
The researchers found that patients with prostate cancer taking between 5 and 9 medications had a 42% higher rate of hospitalization, those taking 10 to 14 medications had a 75% increase, and those taking over 15 medications prior to chemotherapy had a 114% higher rate compared to patients taking fewer than 5 medicines. The researchers saw similar increases in patients with both breast and lung cancers as well.
The study authors concluded, “This large population-based study found that polypharmacy during the 6-month window pre–intravenous chemotherapy is highly predictive of postchemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce postchemotherapy inpatient hospitalization among older patients with cancer.”
Disclosure: This project was supported in part by the SKCC Cancer Center Support Grant and the SKCC Biostatistics Shared Resource. For full disclosures of the study authors, visit geriatriconcology.net.
