Inappropriate Medications Use among Elderly Cancer Patients According to Beer’s Criteria
Main Article Content
Keywords
cancer patients, Jordan, Potentially inappropriate medications (PIMs), Beer’s criteria, elderly
Abstract
Background: The global population of elderly has substantially increased in recent years due to heightened life expectancy and improved survival rates for numerous diseases, including cancer. Cancer treatment often entails complex regimens involving multiple medications. Additionally, advancing age is associated with a higher prevalence of co-morbidities, rendering older individuals more susceptible to inappropriate medications use and adverse drug events. Objective: We aimed in our study to examine the extent of Potentially Inappropriate Medications (PIMs) prescribing and factors associated with more PIMs instances in elderly cancer patients. Methods: The data of this study was evaluated utilizing medical records of included study subjects and was conducted over more than 3 years period (January 1, 2019 to January 31, 2022) at King Abdullah University Hospital, Al Ramtha, Jordan. Beer’s criteria 2019 was used to evaluate and identify the potentially inappropriate drugs prescribed and used among elderly cancer patients. Results: A total number of 250 geriatric cancer patients were included in this study. The mean age of the patients was 73.4 years. Males represented 50.4% of the total patients (n=126). The average number of medications reported was 10.7 medications. Eighty three percent (n=203) of patients had polypharmacy (prescribed at least five medications or more), A total of 179 medications were considered inappropriate according to the 2019 updated BEERS criteria and 71.6% of patients (n=179) received at least one PIM. The most common classes of PIMs were gastrointestinal medications (e.g., metoclopramide). Conclusion: According to this study, the incidence of PIMs in geriatric oncology practice is concerning, and extra consideration should be given to reduce any risks associated with this kind of prescribing in elderly cancer patients. Polypharmacy was found to be a major predictor of PIM prescription in this research.
References
2. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC geriatrics. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2
3. Miller MG, Kneuss TG, Patel JN, et al. Identifying potentially inappropriate medication (PIM) use in geriatric oncology. Journal of geriatric oncology. 2021;12(1):34-40. https://doi.org/10.1016/j.jgo.2020.06.013
4. Sharma M, Loh KP, Nightingale G, et al. Polypharmacy and potentially inappropriate medication use in geriatric oncology. Journal of geriatric oncology. 2016;7(5):346-53. https://doi.org/10.1016/j.jgo.2016.07.010
5. Mohamed MR, Ramsdale E, Loh KP, et al. Association of Polypharmacy and Potentially Inappropriate Medications With Physical Functional Impairments in Older Adults With Cancer. Journal of the National Comprehensive Cancer Network : JNCCN. 2021;19(3):267-74. https://doi.org/10.6004/jnccn.2020.7628
6. Lees J, Chan A. Polypharmacy in elderly patients with cancer: clinical implications and management. The Lancet Oncology. 2011;12(13):1249-57. https://doi.org/10.1016/s1470-2045(11)70040-7
7. Lavan AH, O’Mahony D, Buckley M, et al. Adverse Drug Reactions in an Oncological Population: Prevalence, Predictability, and Preventability. The oncologist. 2019;24(9):e968-e77. https://doi.org/10.1634/theoncologist.2018-0476
8. Al Damen L, Basheti I. Preventability analysis of adverse drug reactions in a Jordanian hospital: a prospective observational study. Int J Clin Pharm. 2019;41(6):1599-610. https://doi.org/10.1007/s11096-019-00925-0
9. Turner JP, Jamsen KM, Shakib S, et al. Polypharmacy cut-points in older people with cancer: how many medications are too many? Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Supportive Care in Cancer. 2016;24(4):1831-40. https://doi.org/10.1007/s00520-015-2970-8
10. Nightingale G, Hajjar E, Swartz K, et al. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. American Society of Clinical Oncology. 2015;33(13):1453-9. https://doi.org/10.1200/jco.2014.58.7550
11. Turner JP, Shakib S, Singhal N, et al. Prevalence and factors associated with polypharmacy in older people with cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Supportive Care in Cancer. 2014;22(7):1727-34. https://doi.org/10.1007/s00520-014-2171-x
12. Awad A, Hanna O. Potentially inappropriate medication use among geriatric patients in primary care setting: A cross-sectional study using the Beers, STOPP, FORTA and MAI criteria. PLoS One. 2019;14(6):e0218174. https://doi.org/10.1371/journal. pone.0218174
13. Karuturi MS, Holmes HM, Lei X, et al. Potentially inappropriate medications defined by STOPP criteria in older patients with breast and colorectal cancer. Journal of geriatric oncology. 2019;10(5):705-8. https://doi.org/10.1016/j.jgo.2019.01.024
14. Saarelainen LK, Turner JP, Shakib S, et al. Potentially inappropriate medication use in older people with cancer: prevalence and correlates. Journal of geriatric oncology. 2014;5(4):439-46. https://doi.org/10.1016/j.jgo.2014.07.001
15. Fede A, Miranda M, Antonangelo D, et al. Use of unnecessary medications by patients with advanced cancer: crosssectional survey. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2011;19(9):1313-8. https://doi.org/10.1007/s00520-010-0947-1
16. Al Odhayani A, Tourkmani A, Alshehri M, et al. Potentially inappropriate medications prescribed for elderly patients through family physicians. Saudi journal of biological sciences. 2017;24(1):200-7. https://doi.org/10.1016/j.sjbs.2016.05.006
17. Al-Omar HA, Al-Sultan MS, Abu-Auda HS. Prescribing of potentially inappropriate medications among the elderly population in an ambulatory care setting in a Saudi military hospital: trend and cost. Geriatrics & gerontology international. 2013;13(3):616- 21. https://doi.org/10.1111/j.1447-0594.2012.00951.x
18. Zeenny R, Wakim S, Kuyumjian YM. Potentially inappropriate medications use in community-based aged patients: a crosssectional study using 2012 Beers criteria. Clinical interventions in aging. 2017;12:65-73. https://doi.org/10.2147/cia.s87564
19. Alhmoud E, Khalifa S, Bahi AA. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. International journal of clinical pharmacy. 2015;37(5):815-21. https://doi.org/10.1007/s11096-015-0125-0
20. Al-Azayzih A, Alamoori R. Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract 2019;17(2):1439. https://doi.org/10.18549/pharmpract.2019.2.1439
21. Jørgensen TL, Herrstedt J. The influence of polypharmacy, potentially inappropriate medications, and drug interactions on treatment completion and prognosis in older patients with ovarian cancer. Journal of geriatric oncology. 2020;11(4):593-602. https://doi.org/10.1016/j.jgo.2019.12.005
22. Ramsdale E, Mohamed M. Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment.Oncologist. 2022;27(7):e580-e8. https://doi.org/10.1093/ oncolo/oyac053
23. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767
24. Karuturi MS, Holmes HM, Lei X, et al. Potentially inappropriate medication use in older patients with breast and colorectal cancer.Cancer.2018;124(14):3000-7. https://doi.org/10.1002/cncr.31403
25. Fried TR, O’Leary J, Towle V, et al. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. Journal of the American Geriatrics Society. 2014;62(12):2261-72. https://doi.org/10.1111/jgs.13153
26. Abu Hammour K, Abdel Jalil M, AlHabeis S, et al. Prevalence of potentially inappropriate prescribing in older adults in Jordan: Application of the STOPP criteria. Australasian journal on ageing. 2021;40(1):e70-e8. https://doi.org/10.1111/ajag.12855