Polypharmacy cut-points in older people with cancer: how many medications are too many?

Justin P Turner, Kris M Jamsen, Sepehr Shakib, Nimit Singhal, Robert Prowse, J Simon Bell

Research output: Contribution to journalArticleResearchpeer-review

57 Citations (Scopus)

Abstract

Purpose: Polypharmacy is often defined as use of ‘five-or-more-medications’. However, the optimal polypharmacy cut-point for predicting clinically important adverse events in older people with cancer is unclear. The aim was to determine the sensitivities and specificities of a range of polypharmacy cut-points in relation to a variety of adverse events in older people with cancer.

Methods: Data on medication use, falls and frailty criteria were collected from 385 patients aged ≥70 years presenting to a medical oncology outpatient clinic. Receiver operating characteristic (ROC) curves were produced to examine sensitivities and specificities for varying definitions of polypharmacy in relation to exhaustion, falls, physical function, Karnofsky Performance Scale (KPS) and frailty. Sub-analyses were performed when stratifying by age, sex, comorbidity status and analgesic use.

Results: Patients had a mean age of 76.7 years. Using Youden’s index, the optimal polypharmacy cut-point was 6.5 medications for predicting frailty (specificity 67.0 %, sensitivity70.0 %), physical function (80.2 %, 49.3 %) and KPS (69.8 %, 52.1 %), 5.5 for falls (59.2 %, 73.0 %) and 3.5 for exhaustion (43.4 %, 74.5 %). For polypharmacy defined as five-or-more-medications, the specificities and sensitivities were frailty (44.9 %, 77.5 %), physical function (58.0 %,69.7 %), KPS (47.7 %, 69.4 %), falls (44.5 %, 75.7 %) and exhaustion (52.6 %, 64.1 %). The optimal polypharmacy cut-points were similar when the sample was stratified by age, sex, comorbidity status and analgesic use.

Conclusions: Our results suggest that no single polypharmacy cut-point is optimal for predicting multiple adverse events in older people with cancer. In this population, the common definition of five-or-more-medications is reasonable for identifying‘at-risk’ patients for medication review.
Original languageEnglish
Pages (from-to)1831–1840
Number of pages10
JournalSupportive Care in Cancer
Volume24
Issue number4
DOIs
Publication statusPublished - 2016

Keywords

  • Aged
  • Polypharmacy
  • Deprescribing
  • Cancer

Cite this