Table 10: Common Malignancies for Older Adult Patients Attributes
Polypharmacy
Prostate cancer
● Most common non-cutaneous cancer in the male population ● Over 225,000 cases in the United States in 2022 ● Median age for prostate cancer diagnosis is approximately 67 ● Median age of death from prostate cancer is age 80 ● The older a man is at diagnosis, the more vulnerable to other age-related chronic conditions ● Older men diagnosed with prostate cancer frequently have multiple cooccurring illnesses such as cardiovascular disease ● Polypharmacy in prostate cancer can directly affect absorption and levels of cancer treatment ● There are often high levels of pill burden confronting these patients ● Supportive care and medication management is crucial to ensure treatment protocols are supporting their outcomes ● Third most common type of cancer, mostly found in older adults, with a mean diagnosis age of 71, median age of death is 73 ● Polypharmacy is common with anticancer protocol ● Drug interactions can occur in patients with early-stage lung cancer ● Lung cancer patients who are frail may risk hospitalization and death with interactions between drugs for comorbid conditions and treatment for their malignancy ● Older adults with IV chemotherapy have increased rates of hospitalization ● Older adults with lung cancer can experience significantly higher rates of morbidity and mortality separate from their cancer diagnosis due to polypharmacy
According to Heibenstreit et al 2019): ● Understanding drug-drug interactions (DDI) is important with all types of cancer ● Development of treatment medications for prostate cancer continues to evolve and currently includes taxane-based chemotherapy (docetaxel, cabazitaxel) or androgen receptor (AR)-directed substances (abiraterone, enzalutamide) ● Prostate cancer patients with symptomatic bone metastases (minus visceral metastases) the radionuclide radium-223 ● To minimize any opportunity for toxicity treatment monitoring must be targeted and specific to adjust dosages and modify exposure to redirect and modify impact ● DDIs occur when there is the introduction of any additional medication or substance, including alcohol ● A pharmacodynamic DDI occurs when a coadministered drug alters the pharmacodynamic effect of another drug, which should be monitored regularly for patients undergoing prostate cancer treatment ● Warfarin’s anticoagulant effect is enhanced when combined with common lung cancer medications including carboplatin, cisplatin, etoposide, gemcitabine, and paclitaxel ● Approximately 15% of lung cancer patients had interactions with warfarin within a 12-month treatment period ● Deprescribing may be an asset to specific lung cancer patients with metastatic non-small cell lung cancer (NSCLC) ● Dexamethasone has major interaction events
Lung cancer
when taken with other drugs, especially antihypertensives, can result in increased nephrotoxicity
(Cheng et al., 2022) Polypharmacy and pain management
● Cognitive impairment ● Increased fall risks ● Impaired functional mobility ● Premature death
Living in chronic pain is considered to be highly prevalent in the older adult population (Domenicello & Ramsden, 2019),
often accompanied by: ● Significant suffering ● Increased loneliness ● Social isolation ● Morbidity and mortality ● Increased pill burden ● Higher healthcare costs
The extent of polypharmacy because of chronic pain in older adults is widely unknown due to underrepresentation in clinical trials focusing on chronic pain. The challenges relative to pain management and polypharmacy abound, compounded by a lack of research in this area, there can be limitations on communication should the older person have cognitive impairment or dementia. Domenicello and Ramsden (2019) suggest that there may be a correlation between persistent pain and dementia, but this is clouded by pain perception combined with communication capability.
There are limitations to addressing and resolving pain in older adults, largely due to limited testing and research evaluating and understanding pharmaceutical interventions. Side effects of chronic pain can include: ● Constipation ● Urinary retention ● Fatigue
EliteLearning.com/Massage-Therapy
Book Code: MTX1326
Page 52
Powered by FlippingBook