The impact of potentially inappropriate medications on performance status, functional status, and overall survival in older adults with prostate cancer.

Abstract

e17018 Background: The 2023 American Geriatric Society's Beers Criteria lists around 100 medications with potential side effects that outweigh their benefits for adults age 65 and older. These medications are collectively referred to as potentially inappropriate medications (PIM). Among the PIMs listed, particular attention is paid to benzodiazepines and medications with strong anticholinergic activity as geriatric patients are more susceptible to their adverse effects. Prostate cancer (PCa) is the fourth most common cancer by incidence worldwide. Roughly 60% of men with PCa are 65 or older. Our study aims to assess the impact of these two classes of PIMs on performance status, functional status, and overall survival in geriatric patients with PCa undergoing treatment. Methods: We utilized data from Global Collaborative Network-TriNetX to assess the impact of benzodiazepines and anticholinergics (first generation antihistamines, antidepressants, antipsychotics, antiparkinsonian agents, barbiturates, Z-drugs, antispasmodics) on performance status, functional status, and overall survival. Patients aged 65 to 90 were divided into two cohorts: those being treated for PCa and receiving PIMs (PIM cohort), and those being treated for PCa and not receiving PIMs (control cohort). Cohorts were propensity score matched based on age, sex, race, baseline ECOG performance status, frailty, falls, bed-confinement status, ambulatory dysfunction, AJCC stage of disease, PSA levels, and underlying renal, cardiovascular, and pulmonary comorbidities. Using ICD-10 codes, we evaluated the following outcomes: ECOG performance status, age-related physical disability, need for assistance with ADLs, bed confinement, ambulatory dysfunction, falls, and overall survival at 1 year. Generalized linear models were used to measure associations and estimates were presented as mean values and odds ratios with 95% confidence intervals. Results: After matching, each cohort consisted of 49,713 patients. The PIM cohort had a mean age of 74.2 +/- 8 years. Caucasians accounted for 54.6% of patients. Over a 1-year period, older adults in the PIM cohort had a statistically worse ECOG performance status (mean 0.67 vs. 0.47, p = 0.012) and a higher risk of death (OR: 2.007, CI 1.92 – 2.10, p < 0.0001), age-related physical disability (OR: 2.22, CI 1.78 – 2.77, p < 0.0001), need for assistance with ADLs (OR: 2.35, CI 1.77–3.11, p < 0.0001), bed confinement (OR: 5.01, 2.88 – 8.72, p < 0.0001), ambulatory dysfunction (OR: 2.53, CI 2.07–3.09, p < 0.0001), and falls (OR: 2.55, CI 2.22–2.93, p < 0.0001). Conclusions: Our study demonstrated that PIM use in geriatric patients undergoing treatment for PCa is associated with worse performance status, functional status, and overall survival, raising the question of whether PIM use reduces patient's eligibility to receive PCa-directed treatment.