● Relevance and incidence of cognitive impairment for older adults with cancer ● Polypharmacy assessments and identifiers for older adults with cancer ● Depression scale for older adults with cancer ● Identification of geriatric syndromes in older adults with cancer It should be noted that for cancer patients, all medications should be reported and monitored throughout the entire length of all pharmacological treatments and protocols. Additional information includes (Cheng et al., 2022): ● Antidepressants and other commonly used medications can interfere with the metabolism of some therapies Table 10: Common Malignancies for Older Adult Patients Attributes
such as processing of tamoxifen in a treatment plan for breast cancer. ● Bruton’s tyrosine kinase inhibitors (ibrutinib), referenced for patients with chronic lymphocytic leukemia, can experience increased bleeding risks. ● Some antidepressants, metformin, and aspirin can prompt antitumor responses in patients with colon cancer. ● Antibiotics taken prior to cancer treatment may worsen certain outcomes, in particular in colon cancer. ● Medication taken for co-occurring conditions may negatively impact the strength of the therapeutic action for second generation hormonal therapies addressing prostate cancer.
Polypharmacy
Breast cancer
● Most common malignancy ● Among women it is the second leading cause of cancer-related death ● Prevalent in older women ● Higher rate of death for diagnosed older women ● Higher risk of polypharmacy ● Frequent comorbidities include arthritis, hypertension, diabetes, gastrointestinal disease ● Some medications must be monitored for decreased effectiveness and potential toxicity ● Fourth most frequently diagnosed cancer ● Leading cause of cancer death ● While younger people are being diagnosed, there is a low increase in people age 50–60 ● Patients frequently engage in polypharmacy, taking medications for comorbidities that include acute coronary syndrome, myocardial infarction and stroke, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, chronic pain, and hypothyroidism
● Patients often prescribed oral therapy ● Adjuvant endocrine therapy with either tamoxifen or an aromatase inhibitor (AI)— anastrozole, exemestane, and letrozole ● Lipid lowering agents ● Diabetes medications ● Antihypertensive ● Additional medications can include anxiolytics, antipsychotics, and antidepressants ● Daily low dose aspirin inhibits inflammation and platelet-derived signals required for the use of specific antitumor immunity ● Antibiotics have been associated with an 18% increase in relative risk of cancer in patients with metastatic colon cancer ● Antidepressants may improve colon cancer survival outcomes—fluoxetine, citalopram, and mirtazapine reduce pro-malignant inflammatory markers that have been found in colon cancer cells ● Metformin has been shown to potentially reduce the risk of colon cancer ● Colon cancer patients require “robust” oversight to manage potential outcomes of polypharmacy ● Bruton’s tyrosine kinase (BTK) inhibitors, ibrutinib, daily oral therapy ● There is typically no endpoint of the treatment ● Adverse effects include cardiac toxicity, bleeding risk, diarrhea, rash, infections, and polypharmacy ● Between 23% and 49% of patients discontinue ibrutinib due to adverse events ● Acalabrutinib is becoming the preferred BTK inhibitor and should be overseen by a cardiologist ● There is increased risk of bleeding with some OTC medications and vitamins, including NSAIDS, vitamin E, and fish oil products
Colon cancer
Chronic lymphocytic leukemia (CLL)
● A common hematologic cancer resulting in bone marrow producing dysfunctional lymphocytes ● Accounts for 40% of leukemias with typical diagnosis at age 70 ● Due to toxicity of treatment, there can be a delay ● Treatment occurs when clinically significant symptoms present, including fatigue, anemia, infection, bulky lymphadenopathy, night sweats, and fevers ● CLL patients are often frail
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Book Code: MTX1326
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