Background:
Polypharmacy is over-represented in the over 65 cohort. Around 65.5% of new cancers in men and 55% in women are diagnosed in those 65 and older. Polypharmacy is a risk for older oncology patients. Hazards include falls, increased hospitalisation rates, morbidity and increased mortality. This study aimed to determine baseline polypharmacy, incident polypharmacy, prescribing practices, and associated characteristics that may influence the older oncology population.
Methods:
This retrospective cohort study analysed clinical and demographic details of a randomly selected group of patients with solid organ malignancies through individually reviewed electronic medical records. We examined the cohort from their first oncology review to three months post initial review. Collected information included age, comorbidities, baseline medication burden, cancer variables, including stage, and prescribing practices. The primary aim was to examine prescribing practices over three months, and to assess the classes of medications that were added or removed. Additionally, we looked for possible drug-drug interactions and adverse events from medications.
Results:
At the time of publication, 107 patients had been analysed out of a planned 300. The median age was 73 (range 65 to 89). 70% had baseline polypharmacy, with the average number of medications being 4 (range 3 to 15). Baseline medications represented pre-existing comorbidities (including chronic cardiovascular, respiratory and endocrine disease). At first review, no deprescription occurred in any patients. 71 % of patients were on or planned to commence cancer-related therapy shortly. The average medication number prescribed after three months was six, with fourteen patients taking over ten medications.
Conclusion:
Our research confirms high baseline polypharmacy and a tendency to prescribe rather than deprescribe. The extra medications administered were primarily anti-cancer treatments and supportive medications. Further research into clinician prescribing, documentation and stakeholder engagement is needed to minimise the risks associated with polypharmacy.