La, Jennifer;
Hshieh, Tammy;
Hamparsumian, Anahid;
Zwolinski, Robert;
Wood, Jameson;
Dharne, Mayuri;
Gaziano, J. Michael;
Brophy, Mary T.;
Do, Nhan;
Munshi, Nikhil C.;
Driver, Jane A.;
Abel, Gregory A.;
Fillmore, Nathanael;
DuMontier, Clark
Potentially inappropriate medications and their association with frailty, unplanned hospitalizations, and mortality in patients with cancer treated in the national U.S. Veterans Affairs Healthcare System
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Medientyp:
E-Artikel
Titel:
Potentially inappropriate medications and their association with frailty, unplanned hospitalizations, and mortality in patients with cancer treated in the national U.S. Veterans Affairs Healthcare System
Beteiligte:
La, Jennifer;
Hshieh, Tammy;
Hamparsumian, Anahid;
Zwolinski, Robert;
Wood, Jameson;
Dharne, Mayuri;
Gaziano, J. Michael;
Brophy, Mary T.;
Do, Nhan;
Munshi, Nikhil C.;
Driver, Jane A.;
Abel, Gregory A.;
Fillmore, Nathanael;
DuMontier, Clark
Erschienen:
American Society of Clinical Oncology (ASCO), 2024
Erschienen in:
Journal of Clinical Oncology, 42 (2024) 16_suppl, Seite 1620-1620
Sprache:
Englisch
DOI:
10.1200/jco.2024.42.16_suppl.1620
ISSN:
0732-183X;
1527-7755
Entstehung:
Anmerkungen:
Beschreibung:
1620 Background: We previously operationalized the NCCN list of high-risk medications in older adults into a measurable scale—Geriatric Oncology Potentially Inappropriate Medications (GO-PIMs)—to aid oncology teams in identifying PIMs and understand their impact (1). This scale revealed that PIMs were prevalent and associated with frailty in older patients with blood cancers. The current study aims to evaluate the ability of GO-PIMs to identify high-risk medications and their impact in patients with both solid and liquid tumors managed in a large national healthcare system. Methods: We performed a retrospective cohort study using data from the national Veterans Affairs (VA) Cancer Registry and electronic health record, including all veterans newly diagnosed with a solid or liquid malignancy in the years 2000-2023.The number of GO-PIMs for each patient were measured among outpatient pharmacy prescriptions in the 90 days preceding the initial diagnosis date (the index date). We evaluated the association of PIMs with baseline frailty (the electronic Veterans Affairs-Frailty Index [VA-FI], categorized as nonfrail [0-0.2], mildly frail [>0.2-0.3], and moderate-to-severely frail [>0.3]), time to unplanned hospitalization, and mortality in multivariable models adjusting for age, gender, cancer type and stage, Charlson comorbidity index, and socioeconomic factors (rurality, area deprivation index, and history of homelessness). Results: Among 307,487 newly diagnosed patients (median age 68.5, IQR 62.1-75.8; most common cancers: prostate [20.5%], lung [23.1%], GI [21.3%]), GO-PIMs were prevalent (39% patients with ≥1 GO-PIM). The most common classes of PIMs were SSRIs (12.4%); opioids (10.7%); benzodiazepines (9.5%), and corticosteroids (9.5%). Each additional PIM increased the odds of being mild or moderate-to-severely frail at diagnosis by 65%, controlling for all covariates (ordinal regression adjusted OR [aOR] 1.65, 95% CI 1.63-1.66). Increasing number of PIMs was also associated with a higher hazard of unplanned hospitalization (Cox regression aHR 1.04, 95% CI 1.04-1.05) and death (Cox regression aHR 1.05, 95% CI 1.05-1.06), controlling for frailty and all covariates. Conclusions: Independently of cancer type and stage, comorbidity, and other covariates, increasing PIMs identified by the GO-PIMs scale was associated with an increased risk of frailty at diagnosis, unplanned hospitalization in follow-up, and death. We are implementing the GO-PIMs scale in a clinician-facing application that will automate real-time detection of PIMs and recommendations for oncology teams in routine clinical practice. 1. Hshieh and DuMontier et al., J Natl Compr Canc Netw, 2022.