Background: Polypharmacy in the geriatric oncology setting is becoming an increasing concern as the number of older patients being actively treated has burgeoned, particularly with the advent of oral targeted agents. At the time of referral to oncology, patients are already on multiple medications and oncologists subsequently introduce significant numbers of extra drugs (including oral chemotherapy and supportive care medications). Cancer-related therapy increases medication-related risk including potential drug-drug interactions, medication duplication and medication confusion. In addition, geriatric oncology patients are often being treated by multiple teams (including but not limited to general practitioner, medical oncology, radiation oncology and palliative care).
Aims: To identify polypharmacy in cancer patients aged > 70 years taking > 5 regular medications and to describe patterns of drug usage during chemotherapy treatment.
Methodology: Over a period of nine months, 22 patients (median age 75.5 years) were randomly selected from the Prince of Wales Oncology Day Centre. Patients were regularly reviewed by the oncology pharmacist for drug-drug interaction check and medication list update. Data was collected over 6 months to identify patterns of drug use and specific pharmacy interventions. This pilot study is to be completed by September 2013.
Initial results: Of 22 patients, 2 were lost to follow up and 3 passed away during the study. The current data identified 83% (6) of patients managed by more than 2 medical teams have > 5 medication or dosage changes in 6 months in comparison to 18% (2) patients with 2 medical teams managing their medications. Other issues have also been identified.
Conclusion: This pilot study demonstrated geriatric oncology patients being managed by multiple teams were at a higher risk of frequent medication changes. It illustrated the importance of regular medication reconciliation and the significance of pharmacy involvement in these high risk patients in the outpatient clinic settings.