The management of polypharmacy in people with cancer and chronic conditions

Polypharmacy has a broad definition, encompassing the use of multiple medications, the use of more medications than necessary, or the use of inappropriate medications. Polypharmacy itself is not necessarily inappropriate, however, it has been associated with negative outcomes in patients with multiple chronic conditions. For people diagnosed with cancer, medications may be prescribed to treat cancer, ameliorate symptoms, improve quality of life and to manage or prevent future complications of chronic diseases. However, the potential benefits of each medication need to be balanced against the potential harms. For example, in studies of older people with cancer, polypharmacy has been associated with greater risk of chemotherapy discontinuation, mortality, grade III-IV toxicity, drug-drug interactions, drug-disease interactions, increased treatment cost and increased use of potentially inappropriate medications (PIMs). Although the possibility confounding by indication cannot be excluded, the results of these studies suggest it is prudent to conduct a comprehensive medication review in patients at risk of adverse drug events. The goal of medication review is not necessarily to reduce a patient’s number of medications, but rather to ensure that each medication is appropriate for the patient’s goal of care, with an acceptable benefit to risk ratio.