COST OF MEDICATION REQUIREMENT DURING RADIOTHERAPY: IMPLICATIONS FOR AN ELDERLY ONCOLOGICAL POPULATION

Abstract

To the Editor: A high incidence of cancer and high consumption of medications accompany aging. In support of the above statement, it is necessary only to note that more than 50% of cancer patients are aged 65 or older1 and that elderly patients (≥65) consume one-third of all prescribed medications in the United States.2 Earlier this year, we performed a prospective, descriptive study investigating the rate of comorbidities, polypharmacy, and the cost of drug prescription in patients who underwent radiotherapy. The result analysis revealed significant differences between younger (<65) and older (≥65) patients. The study was performed in the Department of Radiation Oncology at the University of Patras Medical School, Greece. Patient recruitment took place from February to November 2006. Two hundred outpatients were enrolled in the study. Patient characteristics and demographics are presented in Table 1. Exclusion criteria were interruption of scheduled therapy and combined chemo-radiation. At history taking and weekly thereafter, a detailed record of prescribed medications was kept. Medications that were prescribed before the onset of therapy were also recorded. Medications were characterized as “supportive care” regimens if they were prescribed as a result of complications or toxicity encountered during radiotherapy. Any other medication received by the patient during the course of radiotherapy (including drugs prescribed before radiotherapy because of comorbidities) was defined as “concomitant” medication. The resultant analysis revealed that 56% of patients underwent radical radiotherapy and the rest received palliative therapy. Of the older patients, 78.4% were suffering from comorbidities, and of the younger, 56.2%. Polypharmacy (concurrent consumption of >5 medications) resulting from concomitant medications prescribed before the onset of therapy was more frequent in the older group (30% vs 18%), whereas supportive care medications were more frequent in the younger group. Table 1 presents the main types of concomitant and supportive care medications prescribed during radiotherapy for the older and younger patients, as well as the percentage of patients consuming such medication. Mean total cost (concomitant and supportive care) per patient (2006 prices) for the medications prescribed during radiotherapy was $773 for the older and $1,253 for the younger patients. The mean cost per patient for supportive care medication was $452 for the older and $817 for the younger patients. When costs were analyzed based on the type of treatment (radical or palliative), the same pattern was observed. More specifically, the mean total medication cost per person for the older patients undergoing radical radiotherapy was $937, compared with $1,269 for the younger. Mean total medication cost per patient for older patients undergoing palliative treatment was $545 and for younger patients was $1,233. In conclusion, older patients had a higher rate of comorbidity than younger patients, being prescribed more medications for the management of comorbid disorders. This result was more or less expected, because it is well known from the literature that the prevalence of comorbidities in older people is higher. What was surprising was that, during radiotherapy, the need for supportive care medication was higher for the younger group, resulting in a higher mean total medication cost per patient. This difference was more marked for patients undergoing palliative radiotherapy. The higher cost for supportive care medication for the younger group could be attributed to the fact that younger patients report more concerns about their illness and symptoms.3 The fact that toxicity rates and severity for the two groups during radiotherapy were similar reinforces this. It was also interesting to note that the cost of the supportive care medication was higher than that of the prescribed concomitant drugs. Financial Disclosure: None. Author Contributions: Chara Nikolaou and Maria Pangali: data collection and interpretation of results. Vassiliou Vassilios: data collection and writing of the manuscript. Kardamakis Dimitrios: data analysis and supervision of the letter. Sponsor's Role: None.