Cancer Research, Statistics, and Treatment

LETTER TO EDITOR
Year
: 2021  |  Volume : 4  |  Issue : 2  |  Page : 405--406

Polypharmacy: Common yet unaddressed issue in geriatric oncology


Sabeena K Choudhary, A Sreevalli, Linu Abraham Jacob 
 Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Correspondence Address:
Sabeena K Choudhary
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru - 560 029, Karnataka
India




How to cite this article:
Choudhary SK, Sreevalli A, Jacob LA. Polypharmacy: Common yet unaddressed issue in geriatric oncology.Cancer Res Stat Treat 2021;4:405-406


How to cite this URL:
Choudhary SK, Sreevalli A, Jacob LA. Polypharmacy: Common yet unaddressed issue in geriatric oncology. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 4 ];4:405-406
Available from: https://www.crstonline.com/text.asp?2021/4/2/405/320245


Full Text



Polypharmacy has many definitions including the use of more than five medications, use of more medications than is clinically indicated, use of potentially inappropriate medications (PIMs), medication underuse, medication duplication, etc.[1] This can be a problem in any age group but is more serious in the older patients because of the presence of comorbidities.

We read the article titled, “Polypharmacy and potentially inappropriate medication use in older Indian patients with cancer: A prospective observational study,” by Noronha et al.[2] and the accompanying editorial by Rajesh and Rao with great interest.[3] This is indeed a very well-thought-out study with a great deal of information on a very underrated problem that we come across in daily practice with no definite guidelines. As rightly mentioned by Tripathi, by 2050, the proportion of Indians aged over 60 years is expected to rise to 20%.[4] It is essential that we have a set of consensus guidelines for dealing with the problems we face when treating older patients with cancer, especially the ones with comorbidities.[5]

In this study, the authors have not categorized the patients as per the recent classification of older adults (young old: 65–75 years, old: 75–85, and oldest old: >85 years). Moreover, they have not reported the impact of polypharmacy and the use of PIMs on the patients in each subgroup.[6] This could have helped to better assess the effects of polypharmacy in each subgroup.

The authors have mentioned the use of drugs for comorbidities such as hypertension, diabetes, and heart disease, however, there is no mention of the drugs used for thyroid disorders, which are quite common in many parts of our country. These drugs have a significant effect on the pharmacokinetic and pharmacodynamic parameters of other drugs and may lead to drug interactions.

In addition, in this study, the use of analgesics in terminally ill patients was not considered potentially inappropriate. As mentioned in the article, analgesics were not considered as PIMs in terminally ill patients referred to the palliative care unit. However, analgesics form an important part of cancer treatment, and therefore, their analysis as PIMs during cancer treatment in nonterminally ill patients would have led to a better understanding of the correlation between tumor type and analgesics as PIMs.

Patients with lung cancer were reported to be at a significantly higher risk of polypharmacy in the current study. However, the association between the prevalence of comorbidities in patients with lung cancer and the use of PIMs was not reported.[2] This could have provided better insights into why lung cancer is more associated with polypharmacy. The reason could either be more comorbidities or greater requirement of medications as supportive care in patients with lung primary tumors.

Polypharmacy is still an unaddressed yet important issue that requires well-designed trials for establishing definitive guidelines for managing the geriatric oncology population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. Oncologist 2010;15:507-22.
2Noronha V, Ramaswamy A, Gattani S, Castelino R, Krishnamurthy MN, Menon N, et al. Polypharmacy and potentially inappropriate medication use in older Indian patients with cancer. A prospective observational study. Cancer Res Stat Treat 2021;4:67-70.
3Rajesh V, Rao M. Conundrum of polypharmacy in geriatrics: Less is better than more. Cancer Res Stat Treat 2021;4:127-9.
4Tripathi P. Share of Population Over Age of 60 in India Projected to Increase to 20% in 2050: UN. (Times TE, editor.) India; 2019. Available from: https://economictimes.indiatimes.com/news/politics-and-nation/share-of-population-over-age-of-60-in-india-projected-to-increase-to-20-in-2050-un/articleshow/68919318.cms. [Last accessed on 2021 Apr 20].
5Noronha V, Ramaswamy A, Dhekle R, Talreja V, Gota V, Gawit K, et al. Initial experience of a geriatric oncology clinic in a tertiary cancer center in India. Cancer Res Stat Treat 2020;3:208-17.
6Balducci L. Management of cancer in the elderly. Oncology (Williston Park) 2006;20:135-43.