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There’s a Better Way to Detect High-Risk Medications in Older Adults with Cancer According to New Study in JNCCN
New research highlights the importance of reviewing non-cancer chronic medications linked with frailty in older adults with blood cancers based on NCCN Guidelines list of inappropriate medications, in order to prevent dangerous interactions that may lead to falls or other adverse events.
PLYMOUTH MEETING, PA [August 10, 2022] — A new study in the August 2022 issue of JNCCN—Journal of the National Comprehensive Cancer Network suggests a new way for hematologic oncologists to protect older patients from the risks of medication interactions. As part of the Older Adult Hematologic Malignancies Program, gerontology researchers teamed up with hematologic-oncology investigators from Brigham and Women’s Hospital and the Dana-Farber Cancer Institute to look at the association between older patients with blood cancers who were taking multiple medications and their corresponding frailty. They also created a new scale based on a list of Potentially Inappropriate Medications (PIMs) from the NCCN Guidelines® for Older Adult Oncology—called the Geriatric Oncology-Potentially Inappropriate Medications (GO-PIMs) Scale—and found it to be more effective at predicting frailty than conventional methods.
“A large portion of research for older adults identifies patients as ‘having polypharmacy’ (i.e. taking multiple medications at the same time, leading to a higher risk of adverse events) based on a cutoff of five or more medications; but they don’t specify which medications. Unfortunately, 50% of Americans 75-and-older meet this definition for polypharmacy, making it challenging for busy oncology teams to adequately review chronic medications in order to prevent potential problems,” explained co-lead author Tammy T. Hshieh, MD, MPH, of Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School. “We were interested in the NCCN list of medications of concern because, in contrast to other lists, it was developed by geriatricians and oncologists to be specific for older adults with cancer. We found the GO-PIMs scale we created based on this list carried the strongest association with frailty and can be used by oncology teams to help decrease inappropriate medication usage in an effective way to potentially improve patients’ overall health.”
“The health risks from these specifically identified medications—including falls and fatigue—often outweigh their benefits, especially in older adults whose ability to tolerate side effects are reduced,” said co-lead author Clark DuMontier, MD, MPH, also with Brigham and Women’s Hospital and Harvard Medical School. “Our GO-PIMs tool makes it easier for oncology teams to identify these medications and consider deprescribing them. This scale can also be easily converted into an automated tool that identifies high-risk medications within an electronic health record.”
The researchers examined 785 transplant-ineligible blood cancer patients age 75-and-older treated at Dana-Farber Cancer Institute between February 2015 and November 2019. Frailty was defined by combining two approaches well-established in aging research: the “phenotypic approach,” based on slow gait speed, weakness measured by grip strength, self-reported exhaustion, low physical activity, and weight loss, and the “cumulative deficit approach,” based on the presence of multiple health deficits spanning comorbidity, cognition, and function. Each additional ‘unspecified’ medication in general increased the relative odds of being pre-frail or frail by 8%, while each additional medication on the GO-PIMs scale increased the relative odds by 65%. Compared to robust patients, frail and pre-frail patients were more likely to be taking benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), or corticosteroids.
The study was cross-sectional and it was not possible to determine which came first, the medications or the frailty. However, the researchers did control for conditions that are known to contribute to frailty, and they adjusted for comorbidity severity to reduce the possibility that the association was due to underlying issues rather than the medications themselves.
“The GO-PIMs scale may allow for targeted deprescribing in older adults with blood cancer and could reduce adverse outcomes,” commented Tracey O’Connor, MD, Roswell Park Comprehensive Cancer Center, a Member of the NCCN Guidelines Panel for Older Adult Oncology, who was not involved in this research. “Additional studies are warranted to better define the optimal utilization of this scale and its potential benefits for older adults with cancer.”
To read the entire study, visit JNCCN.org. Complimentary access to “The Association of Polypharmacy and Potentially Inappropriate Medications with Frailty among Older Adults with Blood Cancer” is available until November 10, 2022.
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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.