LETTER TO EDITOR
Year : 2021 | Volume
: 4 | Issue : 2 | Page : 407--408
Authors' reply to Choudhary et al. and Singh et al.
Vanita Noronha1, Vikram Gota2, Kumar Prabhash1,
1 Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Department of Clinical Pharmacology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
Professor and Head, Department of Medical Oncology, Tata Memorial Hospital, Parel, Homi Bhabha National Institute, Mumbai -400 012
|How to cite this article:|
Noronha V, Gota V, Prabhash K. Authors' reply to Choudhary et al. and Singh et al. Cancer Res Stat Treat 2021;4:407-408
|How to cite this URL:|
Noronha V, Gota V, Prabhash K. Authors' reply to Choudhary et al. and Singh et al. Cancer Res Stat Treat [serial online] 2021 [cited 2022 Jan 28 ];4:407-408
Available from: https://www.crstonline.com/text.asp?2021/4/2/407/320246
We thank Choudhary et al. and Singh et al. for their insightful comments regarding our article on polypharmacy and the use of potentially inappropriate medications (PIMs) in older Indian patients with cancer that was published in the previous issue of the journal.
We completely agree with Singh et al.'s comments that the use of unindicated medications adds to the financial toxicity and may cause harm due to various reasons such as drug interactions and adverse effects. In our cohort, lung cancer was the most common primary tumor, noted in 112 (39%) patients. Of these, 24 (21%) patients were planned to receive an oral tyrosine kinase inhibitor, and pantoprazole was being used in 9 (37.5%) of these patients. It is known that pantoprazole reduces the plasma concentration of gefitinib and that the use of proton pump inhibitors should be avoided in patients receiving gefitinib.
Categorizing the patients in our cohort based on age, there were 153 (54%) patients who were young-old (aged 60–70 years), 112 (39%) who were old-old (aged 71–80 years), and 20 (7%) who were oldest-old (aged over 80 years). Polypharmacy and the use of PIMs were noted in 80 (52%) and 124 (81%), 68 (61%) and 90 (80%), and 9 (45%) and 14 (70%) patients in the young-old, old-old, and oldest-old categories, respectively. There was no statistically significant difference in the occurrence of polypharmacy (P = 0.254) or of PIM use (P = 0.506) between the various age categories by the Pearson Chi-square test.
Among 285 patients, nine had a history of hypothyroidism and two had been operated for carcinoma of the thyroid gland; thus, thyroid dysfunction was present in 11 (4%) patients. All these patients were on oral thyroxine supplementation. We agree with Choudhary et al. that, understanding the various drug interactions is an important area of research. However, evaluating the drug interactions was beyond the scope of our study.
We did not assess the medications (including analgesics) for appropriateness only in patients who were terminally ill; we included all the other patients in the assessment for PIM use. In fact, tramadol, an analgesic, was the second most commonly used PIM, noted in 30% of our patients.
In our cohort, of the 112 patients with lung cancer, 82 (73%) had comorbidities and 87 (78%) were receiving PIMs. Moreover, the use of PIMs was significantly higher in patients with lung cancer who had comorbidities than in those who did not (88% vs. 68%, P = 0.047 by Fisher's exact test).
We completely agree with Choudhary et al.'s comment that we need consensus guidelines to help guide the care of older patients with cancer. In our geriatric oncology clinic at the Tata Memorial Hospital, we currently follow the guidelines that have been established by the American Society of Clinical Oncology and the International Society of Geriatric Oncology. However, we have found that many of the geriatric tools are not entirely appropriate for use in Indian patients. Therefore, we hope to be able to generate ethnically appropriate guidelines for the management of our patients in the near future.
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Conflicts of interest
There are no conflicts of interest.
|1||Choudhary SK, Sreevalli A, Jacob LA. Polypharmacy: Common yet unaddressed issue in geriatric oncology. Cancer Res Stat Treat 2021;4:405-6.|
|2||Singh S, Sharma R. Polypharmacy and inappropriate medication use in older patients with cancer: An unaddressed and ubiquitous problem. Cancer Res Stat Treat 2021;4;404-5.|
|3||Noronha V, Ramaswamy A, Gattani SC, 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;4:67-73.|
|4||Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/206995s003lbl.pdf. [Last accessed on 2021 May 30].|
|5||Noronha 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.|
|6||Noronha V, Ramaswamy A, Banavali S, Gattani S, Prabhash K. Ethnocultural inequity in the geriatric assessment. Cancer Res Stat Treat 2020;3:808-13.|