EPIDEMIOLOGY OF POLYPHARMACY IN OLDER PATIENTS WITH CANCER: PROSPECTIVE COHORT STUDY

Introduction: In the Comprehensive Geriatric Assessment (CGA), polypharmacy is one of the risk factors for death and reduction of overall survival, which supports the need to analyze its effects on the outcomes of older patients with cancer still not well represented in scientific research. Objective: The determination of prevalence of polypharmacy and therapeutic subgroups in elderly oncological patients and the association with the occurrence of death at six and twelve months. Methods: A prospective cohort enrolled elderly patients (≥ 60 years) with a recent cancer diagnosis, admitted at a reference hospital in Pernambuco from January 2015 to October 2016. It was considered polypharmacy the use of 5 or more drugs at admission. Multivariate Poisson analyzes were performed to determine the associated factors. Survival curves were estimated using the KaplanMeier method and Coxs proportional hazards model was used to evaluate the risk of death. Results: The mean age of the 747 participants was 71.3 (± 7.4) years, with 51,8% male. The prevalence of polypharmacy was 21.3%. The most commonly prescribed therapeutic subgroups were agents acting on the renin-angiotensin system (44%), diuretics (29.5%) and drugs used in diabetes (25.2%). At the moment of admission, the factors associated with polypharmacy were female, current or pre-existing smoking, and the presence of more than two comorbidities. Age-controlled polypharmacy was identified as an independent factor for death at six months (adjusted hazard ratio [HR] = 1.75, 95% confidence interval [CI] 1.19-2.56), and at twelve months (HR = 1.46, 95% CI 1.05-2.02). Conclusion: Almost onequarter of the older patients at the time of diagnosis of cancer were exposed to polypharmacy which was mainly represented by medications for the control of cardiovascular diseases and diabetes. The use of five or more medication was associated with reduction of overall survival in the first six and twelve months after diagnosis of cancer. Polypharmacy is an important tool in AGA application, which can help the oncologist and his multidisciplinary team assess the need for longterm prescriptions for elderly cancer patients and their increased risk of death.

 

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Artikel online veröffentlicht:
23. Oktober 2019