Association of Polypharmacy and Potentially Inappropriate Medications With Frailty Among Older Adults With Blood Cancers
Harvard Medical School, Boston, Massachusetts;
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Harvard Medical School, Boston, Massachusetts;
New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts;
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Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Harvard Medical School, Boston, Massachusetts;
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Background: Polypharmacy and potentially inappropriate medications (PIMs) are common among older adults with blood cancers, but their association with frailty and how to manage them optimally remain unclear. Patients and Methods: From 2015 to 2019, patients aged ≥75 years presenting for initial oncology consult underwent screening geriatric assessment. Patients were determined to be robust, prefrail, or frail via deficit accumulation and phenotypic approaches. We quantified each patient’s total number of medications and PIMs using the Anticholinergic Risk Scale (ARS) and a scale we generated using the NCCN Medications of Concern called the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. We assessed cross-sectional associations of PIMs with frailty in multivariable regression models adjusting for age, gender, and comorbidity. Results: Of 785 patients assessed, 603 (77%) were taking ≥5 medications and 421 (54%) were taking ≥8 medications; 201 (25%) were taking at least 1 PIM based on the ARS and 343 (44%) at least 1 PIM based on the GO-PIM scale. Among the 468 (60%) patients on active cancer treatment, taking ≥8 medications was associated with frailty (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92–4.17). With each additional medication, the odds of being prefrail or frail increased 8% (aOR, 1.08; 95% CI, 1.04–1.12). With each 1-point increase on the ARS, the odds of being prefrail or frail increased 19% (aOR, 1.19; 95% CI, 1.03–1.39); with each additional PIM based on the GO-PIM scale, the odds increased 65% (aOR, 1.65; 95% CI, 1.34–2.04). Conclusions: Polypharmacy and PIMs are prevalent among older patients with blood cancers; taking ≥8 medications is strongly associated with frailty. These data suggest careful medication reconciliation for this population may be helpful, and deprescribing when possible is high-yield, especially for PIMs on the GO-PIM scale.
Submitted March 3, 2022; final revision received May 12, 2022; accepted for publication May 13, 2022.
Author contributions: Conceptualization: Hshieh, DuMontier, Stone, Soiffer, Driver, Abel. Data curation: Hshieh, DuMontier, Juang, Bahl. Formal analysis: Juang. Funding acquisition: Stone, Soiffer. Investigation: Hshieh, DuMontier, Bahl, Driver. Methodology: Hshieh, DuMontier, Jaung, Hawley, Mozessohn, Driver, Abel. Project administration: Hshieh, DuMontier, Driver, Abel. Resources: Abel. Software: Juang. Supervision: Hshieh, DuMontier, Driver, Abel. Validation: Hshieh, DuMontier, Bahl, Abel. Visualization: Hshieh, DuMontier, Juang, Bahl, Hawley, Mozessohn, Driver, Abel. Writing–original draft: Hshieh, DuMontier. Writing–review and editing: Bahl, Hawley, Mozessohn, Stone, Soiffer, Driver, Abel.
Disclosures: Dr. Stone has disclosed serving on a data safety monitoring board for ACI Clinical, Aptevo Therapeutics Inc., Syntrix Pharmaceuticals, and Takeda Pharmaceutical North America, Inc.; and serving on an advisory board for AbbVie, Inc., Actinium Pharmaceuticals, Inc., Amgen Inc., Arog Pharmaceuticals, Inc., BerGenBio, Bristol-Myers Squibb Company, Boston Pharmaceuticals, CTI BioPharma Corp., GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Jazz Pharmaceuticals Inc., Kura Oncology, Inc., and Novartis Pharmaceuticals Company. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by Dana-Farber Murphy Family Fund for Hematologic Malignancies (T.T. Hshieh, N.E. Bahl, G. Abel); Dana-Farber/Harvard Cancer Center SPORE in Multiple Myeloma (NCI of the NIH: P50 CA100707; C. DuMontier); and Boston Claude D. Pepper Older Americans Independence Center, National Institute on Aging of the NIH under award number P30-AG013679 (C. DuMontier).
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