Polypharmacy: The Other Drug Problem

Calling it America’s “other big drug problem,” advanced practice pharmacist Ginah Nightingale, PharmD, BCOP, set the stage for a discussion on a critical issue of concern for geriatric cancer patients: polypharmacy.  This third of six webinars presented as part of ACCC's Multidisciplinary Approaches to Caring for Geriatric Patients with Cancer project, delved into how excessive prescribing for older adults can unnecessarily complicate their care and even endanger their lives. During the May 6 webinar, Time for a reMEDy: A Focus on Pharmacy and the Older Adult, Dr. Nightingale, who is Associate Professor in the Department of Pharmacy at Thomas Jefferson University in Philadelphia, addressed the potential impact of multiple medications among older adults, particularly those who are receiving cancer treatment.

“Polypharmacy” is a concept that generally refers to a patient taking five or more medications. Dr. Nightingale says national data indicate that more than one-third of older Americans fall under this definition. This can pose serious complications for patients (and even more so for cancer patients), since the more medications a person takes, the greater the risk for adverse reactions. The problem is exacerbated by a fragmented healthcare delivery system, in which care is often not coordinated among multiple providers, care sites, and pharmacies.

For senior adult patients with cancer, the situation can be compounded for individuals who can become caught up in what Dr. Nightingale describes as a “prescribing cascade.” This occurs when a side effect of an oncology drug is interpreted as a new symptom, so an additional drug is prescribed to treat it. This pattern can repeat itself multiple times, until a patient and/or caregiver is juggling numerous prescription bottles.

In her presentation, Dr. Nightingale discussed pharmacy-led medication assessments as a recommended step in patient safety and decision-making. Her preferred method is asking a patient to bring all of his/her medications in a bag to an office visit. More than medication reconciliation, an assessment involves a clinician—ideally, a dedicated oncology pharmacist—reviewing with a patient each drug and assessing the patient’s understanding of the drug’s use, indication, dosage, frequency, and duration. Medication assessment allows for evaluation of potential drug-drug and drug-disease interactions, as well as how a patient’s psychosocial status may affect adherence. There are a number of de-prescribing tools and algorithms that can help clinicians safely transition patients off medications that provide no clinical benefit or pose danger to the patient, while increasing adherence to the remaining required therapies.

If you missed Dr. Nightingale’s webinar, or any other webinar in ACCC’s series on multidisciplinary approaches to caring for geriatric patients with cancer, you can view them on-demand here. All webinars require registration and are free of charge. Access related resources for addressing polypharmacy in older adults patients on the project's resource page.