Health
Polypharmacy can cause harmful drug interactions, especially among cancer patients
This is a very common scenario and applies to nearly 92% of older people with cancer. An individual comes to treatment and reports that he is taking some medications that may include medications for high blood pressure and heart disease, antidepressants, or diabetes. You may also frequently take advir, over-the-counter tablets, antihistamines, vitamins and minerals to relieve heartburn and regurgitation. However, patients may not report these frequently to the medical team.
The formulation of this soup defines “polypharmacy”, or the simultaneous use of multiple drugs-; this can make drug interactions that are harmful to humans more likely. This is especially dangerous for cancer patients seeking treatment.
Even individuals who do no Erica Ramsdale, MD, an oncologist at the Wilmot Cancer Institute, a geriatrics expert, and data scientist who led recent research on polypharmacy, said: Oncologist journal.
As doctors, we tell people to take medicine, but we don’t always do a great job of follow-up. From the patient’s point of view, it may be difficult to stop taking the drug if it is determined that the drug is no longer needed. There is a feeling of “what happens if I quit?” Or “Are you giving up on me?” There is a lot of uncertainty and emotion associated with this problem. “
Erica Ramsdale, Doctor of Medicine, Oncologist at Wilmot Cancer Institute, Geriatrics Specialist, Data Scientist
The longer the list of medicines and supplements a person takes, the higher the risk of improper use and serious drug interactions, she said.
The fragmented nature of health care across disciplines complicates the problem. “Sometimes there is no quarterback,” Ramsdale said, which can result in a “prescription cascade,” where additional medications are given to offset the harmful side effects of the original medication.
Wilmot researchers analyzed a national sampling of 718 adults with stage 3 or 4 cancer and other general health conditions with an average age of 77 years and their drug use. They were looking for potentially inappropriate drugs that were at higher risk than benefits (known as PIMS), drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). The consequences of drug interactions include falls, hypofunction, and death. Patients taking some medications are also more likely to suffer from anxiety and depression.
Of the 718 patients, 70% were at risk of drug-drug interactions and 67% were taking at least one drug that was considered potentially inappropriate.
In fact, 61 percent of patients were taking 5 or more medications before starting chemotherapy-; and nearly 15 percent were taking 10 or more medications.
Other eye-catching facts:
- Nearly 68% of patients had serious health problems other than cancer and needed related medications. The most common was cardiovascular disease. When a person has cancer combined with other health conditions, there is a greater risk of toxicity from cancer treatment with polypharmacy.
- Approximately 10% of hospitalizations in the elderly are associated with dangerous drug interactions. Among elderly people with cancer receiving chemotherapy, polypharmacy is associated with a dramatic increase in unplanned hospitalizations (up to 114%).
- Cholesterol-lowering drugs, minerals, and thyroid therapies are most commonly involved in potential drug interactions.
- Over 25 percent of the medications used by patients in this study were unprescribed-; and these accounted for 40 percent of the potentially inappropriate medications detected by the researchers.
- Common non-prescription medications included vitamins and minerals, anemia medications such as ferrous sulfate, and medications for acid-related disorders and constipation.
“Elderly people may mistakenly assume that over-the-counter medicines are safe for them,” the author writes. “This study helps to delineate the size and shape of problems that are not recognized by both healthcare providers and patients.”
It’s also an under-researched issue, Ramsdale said-; by including over-the-counter medications, Wilmot’s data sets it apart from previous studies. Most multidrug studies in cancer patients focus only on prescription drugs.
This study highlights educational and problem-solving opportunities, such as “unprescribing” some medications.
Prescription removal is a drug reduction planned to avoid harm. Doctors take into account the risks and benefits of each drug, as well as the patient’s life expectancy. For example, statins taken for hypercholesterolemia have no immediate effect. They are intended for prevention and can take up to 10 years to affect. Therefore, if the patient is old and has incurable cancer, he or she may not need to take statins. (According to Ramsdale’s publication, the discontinuation of statins in this setting is supported by groundbreaking research.)
But these conversations can be very delicate, Ramsdale said. Her goal is to promote a better quality of life, and she is conducting clinical trials to test the best way to intervene in the case of polypharmacy among the elderly with cancer. increase.
Source:
Journal reference:
Ramsdale, E. , et al. (2022) Polypharmacy, potentially inappropriate drug therapy, and drug-drug interactions in the vulnerable elderly with advanced cancer who initiate cancer treatment. Oncologist.. doi.org/10.1093/oncolo/oyac053..
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