Polypharmacy in elders with cancer: An analysis of the Ohio medicaid population

Abstract

19550 Background: Polypharmacy in the elderly complicates therapy, increases cost of treatment and is a challenge to healthcare agencies. However, the impact of polypharmacy on the care of the older cancer patient has been poorly described. The objective of this study was to characterize the use of pharmacy drugs in the month preceding cancer diagnosis among Ohio Medicaid beneficiaries 65 years of age or older, and diagnosed with incident breast, prostate, or colorectal cancer during the study period 1997–2001. Methods: Medicaid beneficiaries were identified by linking data from the Ohio Cancer Incidence Surveillance System (OCISS) with Medicaid enrollment and claims files on a year-by-year basis. Because of potentially incomplete claims history, the study was limited to patients who were enrolled in Medicaid continuously in the year preceding initial cancer diagnosis. Additionally, those with spenddown or nursing home stay in that time frame were excluded from the analysis. Demographics, anatomic cancer site and stage were retrieved from the OCISS, and all non-pharmacy claims for services received in the year prior to cancer diagnosis were accounted for in deriving the Charlson comorbidity score. Results: The study population included 652 patients: 282 with incident breast cancer, 111 with prostate cancer, and 259 with colorectal cancer. The median age was 73, 74, and 75 years among breast, prostate, and colorectal cancer patients, respectively. Nearly 45% were prescribed at least one type of medication in the month preceding cancer diagnosis. Of those with any prescription in that time period, nearly 49% were prescribed 5 or more types of medications. The most commonly prescribed types of medication were narcotic analgesics, diuretics and potassium replacement, anti- hypertensive agents, laxatives, antianxiety drugs, and antidpressants. No significant variations in the use of medications were observed across the different subgroups of the study population. Conclusions: Polpypharmacy (5 or more types of medication) was present in more than 22% of patients in this study population. The effects of polpypharmacy above and beyond that of comorbidities, disability, and other geriatric syndromes, relative to cancer-related outcomes should be determined. No significant financial relationships to disclose.