Frailty is associated with polypharmacy and the use of potentially inappropriate medications (PIMs) in older patients with hematologic malignancies, a new study suggests.
Patients taking PIMs and those taking 8 or more medications were more likely to be frail or prefrail, regardless of age, sex, or the presence of comorbidities, researchers found.
These findings were published in the Journal of the National Comprehensive Cancer Network.
The study included 785 patients with hematologic malignancies who were 75 years of age or older. They presented for their initial oncology visit to Dana-Farber Cancer Institute in Boston between February 2015 and November 2019.
Patients had leukemia (n=240), lymphoma (n=272), or myeloma (n=273), and 60% had received oncologist recommendations to start or continue on active cancer treatment.
All patients underwent an in-person geriatric assessment in which they were classified as robust, prefrail, or frail. Most patients were prefrail (58%), though 25% were considered robust, and 17% were classified as frail.
PIMs were quantified using the anticholinergic risk scale (ARS) and a scale the researchers developed called the “Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale.” PIMs were defined as medications that have alternatives with better safety profiles, such as oral corticosteroids, sedatives, antihistamines, opioids, and antipsychotics.
Polypharmacy was common in the cohort, with 77% of patients taking at least 5 medications and 54% taking at least 8. The percentage of patients taking at least 1 PIM was 25% according to the ARS and 44% according to the GO-PIM scale.
When compared with robust patients, those who were prefrail or frail were more likely to be taking benzodiazepines (P =.031), selective serotonin reuptake inhibitors (P =.009), and opioids (P <.001).
Frailty was significantly associated with the use of at least 8 medications among patients recommended to be on active anticancer treatment (adjusted odds ratio [aOR], 2.82; 95% CI, 1.92-4.17).
The odds of being prefrail or frail increased by 8% for each additional medication taken (aOR, 1.08; 95% CI, 1.04-1.12), by 19% with each 1-point increase in ARS (aOR, 1.19; 95% CI, 1.03-1.39), and by 65% with each added PIM on the GO-PIM scale (aOR, 1.65; 95% CI, 1.34-2.04).
“These data suggest careful medication reconciliation for this population may be helpful, and deprescribing when possible is high-yield, especially for PIMs on the GO-PIM scale,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Hshieh TT, DuMontier C, Jaung T, et al. Association of polypharmacy and potentially inappropriate medications with frailty among older adults with blood cancers. J Natl Compr Canc Netw. 2022;20:915-923.e5. doi:10.6004/jnccn.2022.7033