Polypharmacy in Older Adults with Cancer: Evaluating Polypharmacy as Part of the Geriatric Assessment

Abstract

Polypharmacy is a significant public health problem that disproportionally affects older adults who are considered to be the highest consumers of medications. Cancer-related therapy can intensify the prevalence of polypharmacy; however, polypharmacy has inconsistently been included as part of the comprehensive geriatric assessment (CGA). This inconsistency is likely attributed to conflicting study results demonstrating a correlation between polypharmacy and clinical outcomes in older adults with cancer. Despite these inconsistencies, several national and international organization guidelines recommend conducting a polypharmacy evaluation as part of the CGA. Some preliminary data suggests a correlation between polypharmacy and negative health outcomes in older adults with cancer including adverse drug events, falls, frailty, hospitalization, postoperative complications, and poorer overall survival. This review describes the age-related changes that influence the prescribing of medication for older patients with cancer and some of the most common methods for evaluating polypharmacy as part of the CGA. Changes in the pharmacokinetics and pharmacodynamics of the drugs related to aging and the possibility of end-organ dysfunction must be taken into consideration, particularly the age-related decline of glomerular filtration rate that is not always reflected by an increase in serum creatinine. Interventional studies are still needed to determine how to best evaluate polypharmacy and tailor medication use as part of the CGA in order to reduce the risk of adverse drug reactions when receiving chemotherapy and/or supportive care.