Loss of functional autonomy in medication management after start of therapy in older patients with haematological malignancies

Abstract

Purpose: Guidelines on older cancer patients recommend a comprehensive geriatric assessment, preferably including an item on medication management since cancer treatment further increases risks of polypharmacy. So far, little attention is given to non-adherence due to functional changes. We aimed to assess autonomy in medication management after start of therapy in older patients with haematological malignancies. In case of deterioration, we aimed to search for predetermining factors.

Methods: Longitudinal single centre cohort study in patients ≥ 70 years.  Patients underwent a geriatric evaluation before and two months after start of therapy. Medication was registered both times.

Results: Sixty two patients, median age 77 years, were included. At baseline 49 patients (79%) took their long-term medication independently. Independent medication management was significantly higher in patients taking <5 medications (93.7% vs. 63.3%, p < 0.005). After start of therapy, polypharmacy rates increased from 48.3% to 98.3% (n=61) while 55.6% of the initially independent patients became dependent for medication management. Median increase in the number of medications was significantly higher in dependent patients (6 vs. 4.5, p<0.05). Multiple daily doses (80%, n=50), varying doses (59.7%, n=37) and medication splitting (45.3%, n=27) further contributed to regimen complexity. Unlike results at baseline, no correlations were found between autonomy in medication management and medication regimen two months after start of therapy.

Conclusion: Haematological patients are confronted with extensive changes in medication.  A considerable number becomes dependent for medication management. Emphasis should be put on detection and remediation, taking into consideration the challenges of an ambulatory setting.