Experience with Lexicomp® Online Drug Database for Medication Review and Drug-Drug Interaction Analysis within a Comprehensive Geriatric Assessment in Elderly Cancer Patients

• Lies Pottel

  Cancer Center, General Hospital Groeninge, Kortrijk, Belgium

• Michelle Lycke

  Cancer Center, General Hospital Groeninge, Kortrijk, Belgium

• Tom Boterberg

  Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

• Lore Ketelaars

  Cancer Center, General Hospital Groeninge, Kortrijk, Belgium

• Hans Pottel

  Faculty of Medicine, Catholic University Leuven Kulak, Kortrijk, Belgium

• Laurence Goethals

  Cancer Center, General Hospital Groeninge, Kortrijk, Belgium

• Nele Van den Noortgate

  Department of Geriatrics, Ghent University Hospital, Ghent, Belgium

• Fréderic Duprez

  Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

• Wilfried De Neve

  Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

• Sylvie Rottey

  Department of Medical Oncology, Heymans Institute of Pharmacology, Ghent University Hospital, Ghent, Belgium

• Kurt Geldhof

  Department of Medicine, Jan Yperman Hospital, Ypres, Belgium

• Koen Van Eygen

  Department of Medicine, General Hospital OLV Lourdes, Waregem, Belgium

• Khalil Kargar-Samani

  Department of Oncology, Centre Hospitalier de Wallonie Picarde, RHMS, Tournai, Belgium

• Véronique Ghekiere

  Department of Geriatrics, General Hospital Groeninge, Kortrijk, Belgium

• Anne Verhaeghe

  Department of Pharmacy, General Hospital Groeninge, Kortrijk, Belgium

• Philip R. Debruyne

  Cancer Center, General Hospital Groeninge, Kortrijk, Belgium

Background: We studied the use of Lexicomp®, an online drug information database, for adequate identification of drug-drug interactions (DDIs) within Comprehensive Geriatric Assessment (CGA) in cancer patients. Materials and Methods: Data of 149 onco-geriatric patients were reviewed. Sixty-three percent participated in an observational study recruiting head and neck cancer patients (H&N-group), 37% in a registry recruiting general oncology patients (GO-group). Baseline drug information was collected by a health professional, through the medical interview within CGA. Drug class usage was quantified and potential DDIs were assessed and categorized (risk rating "C": monitor therapy, "D": consider therapy modification, "X": avoid combination) with Lexicomp®. Results: On average, H&N and GO-patients took 5 and 8 prescription drugs at presentation, respectively. An average of 4 drugs were added in both groups as part of their proposed therapy. Potential DDIs (n=211 H&N; n=247 GO) were detected by Lexicomp® in 64.9% (85.3% "C", 14.7% "D", 0% "X") and 83.6% (83.4% "C", 15.8% "D", 0.8% "X") of H&N and GO patients, respectively, at therapy start. Administration of cancer-therapy-related drugs lead to additional DDIs (n=75 H&N; n=68 GO) in 73.7% and 58.3% of H&N and GO cases, respectively. DDIs occurred mainly with supportive drugs (100% H&N and 83.8% GO). Sixteen percent of potential DDIs were identified with anti-neoplastic drugs in the GO-group. In 28.7% and 60.0% of H&N and GO patients, respectively, at least one drug was not recognized by Lexicomp®. Conclusions: Use of Lexicomp® drug database within CGA is feasible. It could reduce the administration of inappropriate drugs, and in that way improve the quality of patient-individualized therapy.

Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997; 80(7): 1273-83.http://dx.doi.org/10.1002/(SICI)1097-0142(19971001)80:7<1273::AID-CNCR13>3.0.CO;2-4

Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457-65.

Corcoran ME. Polypharmacy in the Older Patient With Cancer. Cancer Control 1997; 4(5): 419-28.

Wright RM, Warpula RW. Geriatric pharmacology: safer prescribing for the elderly patient. J Am Podiatr Med Assoc 2004; 94(2): 90-7.

Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management. J Clin Pharm Ther 2007; 32(2): 169-75.http://dx.doi.org/10.1111/j.1365-2710.2007.00815.x

Chen CC, Kenefick AL, Tang ST, McCorkle R. Utilization of comprehensive geriatric assessment in cancer patients. Crit Rev Oncol Hematol 2004; 49(1): 53-67.http://dx.doi.org/10.1016/S1040-8428(03)00098-2

Blower P, de Wit R, Goodin S, Aapro M. Drug-drug interactions in oncology: why are they important and can they be minimized? Crit Rev Oncol Hematol 2005; 55(2): 117-42.http://dx.doi.org/10.1016/j.critrevonc.2005.03.007

Extermann M, Aapro M, Bernabei R, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005; 55(3): 241-52.http://dx.doi.org/10.1016/j.critrevonc.2005.06.003

Clauson KA, Marsh WA, Polen HH, Seamon MJ, Ortiz BI. Clinical decision support tools: analysis of online drug information databases. BMC Med Inform Decis Mak 2007; 7: 7.http://dx.doi.org/10.1186/1472-6947-7-7

Polen HH, Zapantis A, Clauson KA, Jebrock J, Paris M. Ability of online drug databases to assist in clinical decision-making with infectious disease therapies. BMC Infect Dis 2008; 8: 153.http://dx.doi.org/10.1186/1471-2334-8-153

Pottel L, Boterberg T, Pottel H, et al. Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapy. J Geriatr Oncol 2012; 3(1): 24-32.http://dx.doi.org/10.1016/j.jgo.2011.11.006

Bellera CA, Rainfray M, Mathoulin-Pelissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 2012; 16.

Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 2001; 49(12): 1691-9.http://dx.doi.org/10.1046/j.1532-5415.2001.49281.x

Belgian Center for Pharmacotherapeutic Information (Belgisch Centrum voor Farmacotherapeutische Informatie, B.C.F.I. VZW). Available from: http: //www.bcfi.be; http: //www.cbip.be.

Gecommentarieerd Geneesmiddelenrepertorium. 22ste editie; D/2008/0435/1 ed: Belgisch Centrum voor Farmacotherapeutische Informatie (BCFI); 2009.

Lexicomp® interaction analyser (Lexicomp® Inc., Ohio, USA). [cited 2010 - 2012] ; Available from: http://www.uptodate.com

Extermann M. Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 2000; 35(3): 181-200.http://dx.doi.org/10.1016/S1040-8428(00)00090-1

Kruse AL, Bredell M, Luebbers HT, Gratz KW. Head and neck cancer in the elderly: a retrospective study over 10 years (1999 - 2008). Head Neck Oncol.2010, 2:25.

Freyer G, Geay JF, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 2005; 16(11): 1795-800.http://dx.doi.org/10.1093/annonc/mdi368

Wildiers H. Mastering chemotherapy dose reduction in elderly cancer patients. Eur J Cancer 2007; 43(15): 2235-41.http://dx.doi.org/10.1016/j.ejca.2007.06.013

Davis MP, Homsi J. The importance of cytochrome P450 monooxygenase CYP2D6 in palliative medicine. Support Care Cancer 2001; 9(6): 442-51.http://dx.doi.org/10.1007/s005200000222

Chutka DS, Evans JM, Fleming KC, Mikkelson KG. Symposium on geriatrics--Part I: Drug prescribing for elderly patients. Mayo Clin Proc 1995; 70(7): 685-93.http://dx.doi.org/10.4065/70.7.685

Giron MS, Wang HX, Bernsten C, Thorslund M, Winblad B, Fastbom J. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001; 49(3): 277-83.http://dx.doi.org/10.1046/j.1532-5415.2001.4930277.x

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279(15): 1200-5.http://dx.doi.org/10.1001/jama.279.15.1200

Rivkin A, Yin H. Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients. J Crit Care. 2011;26(1):104.e1-6. Epub 2010 Jun 19.

Karas S Jr. The potential for drug interactions. Ann Emerg Med 1981; 10(12): 627-30.http://dx.doi.org/10.1016/S0196-0644(81)80085-6

Knight EL, Avorn J. Quality indicators for appropriate medication use in vulnerable elders. Ann Intern Med 2001; 135(8 Pt 2): 703-10.

Shekelle PG, MacLean CH, Morton SC, Wenger NS. Acove quality indicators. Ann Intern Med 2001; 135(8 Pt 2): 653-67.

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