Comparative outcomes and sociodemographic disparities in moderate or excessive polypharmacy among older adults with solid tumors.

Abstract

e13846 Background: Polypharmacy is pervasive among older adults with solid tumors, a high-risk population vulnerable to functional/cognitive decline and healthcare encounters. Limited research addresses how inappropriate prescribing exacerbates these issues or examines disparities among racial groups, who may face compounding social determinants of health (SDoH). This study investigates the intersection of polypharmacy and SDoH to guide targeted interventions in geriatric oncology. Methods: This nationwide retrospective analysis used TriNetX, a repository of aggregated EHR data. Adults > 65 years (Jan 2016-Jun 2023) with solid tumors prescribed ≥5 medications (meds) from the American Geriatrics Society Beers Criteria or Geriatric Oncology Potentially Inappropriate Meds list were included. We excluded patients (pts) with hematologic malignancy, metastatic disease, or incomplete data. Pts were stratified into 5-7 meds and > 8 meds, then by racial groups (Asian, Black, White, Other). Pts were matched for age, sex, Charlson comorbidity index, mood disorders, HbA1c, GFR, chemotherapy, radiation, meds, and SDoH. Competing risks analysis identified med classes most associated with hospital encounters. Primary outcomes were incidence of functional/mobility, cognitive, and social support issues. Secondary outcome included hospital utilization. Median follow-up time was 24 months. Multivariate Cox proportional hazards analyses with hazard ratios (HR) and confidence intervals (CI) were used to compare time-to-event rates. Results: We identified 170,191 eligible pts (mean age 71.7 ± 6.7; 50% female; 86% White, 8% Black, 3% Asian, 3% Other). Cumulative incidence for hospital encounter was highest for steroids (20.9%), NSAIDs (19.6%), opioids (12.0%), benzodiazepines (9.9%), and antihistamines (8.3%). Pts prescribed > 8 meds were 71.9% more likely to have frequent falls or limited function/mobility (HR 1.72, 95%CI 1.66-1.78), 32.7% more likely to experience age-related cognitive decline or delirium (HR 1.33, 95%CI 1.24-1.42), and 18.8% more likely to have social support/functioning issues (HR 1.19, 95%CI 1.01-1.43). Pts prescribed > 8 meds were at greater risk for ED visit (HR 1.50, 95%CI 1.45-1.54), hospitalization and rehospitalization (HR 1.48, 95%CI 1.42-1.54), and ICU admission (HR 1.47, 95%CI 1.35-1.60). Black pts were at greatest risk for cognitive deficits (HR 1.51, 95%CI 1.26-1.82) and social support detriments (HR 1.72, 95%CI 1.10-3.46). Conclusions: Excessive polypharmacy ( > 8 meds) among older adults with cancer is associated with heightened risk of functional decline, cognitive impairment, and increased healthcare utilization. Racial disparities were observed, particularly in Black patients, underscoring the urgent need for tailored interventions to address prescribing practices and reduce inequities in geriatric care.