Polypharmacy discussions in older adults with newly diagnosed acute myeloid leukemia (AML).

Abstract

e13760 Background: Polypharmacy, the use of ≥5 medications, is common in older adults and associated with worse outcomes in AML. A greater understanding of polypharmacy concerns during upfront AML treatment decisions could facilitate medication optimization. We explored how polypharmacy concerns were discussed and addressed by the oncologist during initial treatment visits with older adults newly diagnosed with AML in a pilot randomized controlled trial of a geriatric assessment and value-based decisional intervention (UR-GOAL). Methods: Patients ≥60 years with AML were randomized to UR-GOAL or usual care. In UR-GOAL, oncologists received a geriatric assessment summary report including polypharmacy findings. Initial treatment decision-making encounters were audio-recorded and transcribed. Polypharmacy concerns were coded independently by three coders, and oncologist responses were categorized as addressed, acknowledged, or dismissed. Results: We included 53 patients (27 UR-GOAL, 26 usual care). Median age was 74 (IQR 68-79), 30% females, and 91% White. Baseline polypharmacy was less common in UR-GOAL vs. usual care (33 vs. 54%). The average number of polypharmacy concerns per patient was 0.85 for usual care and 0.63 for UR-GOAL. Concerns involved drug-related side effects (33%), drug-drug interactions (26%), high-risk medications per Beer’s criteria (13%), medication count (10%), supportive medications (8%), and unspecified issues (10%) (See Table 1 for details). Most were raised by oncologists (54%), followed by caregivers (26%), and patients (21%). Common interventions were patient information and counseling (38%), non-cancer treatment modification (34%), and interprofessional communication (13%). Concerns were more often addressed in UR-GOAL than usual care (88% vs. 77%), particularly side-effects (80% vs. 50%). Conclusions: In this secondary analysis of older adults with newly diagnosed AML, common polypharmacy concerns during treatment decision-making included drug-related side effects, drug–drug interactions, and high-risk medications per Beer’s criteria. Future interventions could be designed to better address these common concerns. Specific polypharmacy concerns by common themes. Specific concerns # of concerns Who initiated the concern (# of concerns) Interaction of vitamins, herbs, cannabis, and probiotics with chemotherapy 8 Caregiver (4), Patient (2), Oncologist (2) Side effects of home medications 7 Oncologist (5), Caregiver (1), Patient (1) Bleeding risk from antiplatelet or anticoagulation while on chemotherapy 6 Oncologist (3), Patient (2), Caregiver (1) Side effects of antimicrobials 5 Patient (3), Oncologist (2) Adjustment of home medications 4 Oncologist (3), Caregiver (1) Ability to manage multiple home medications 4 Oncologist (3), Caregiver (1) Interaction of anti-fungal and antibiotics with chemotherapy 3 Caregiver (2), Oncologist (1)