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Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer.

Publication ,  Journal Article
McDermott, CL; Curtis, JR; Sun, Q; Fedorenko, C; Kreizenbeck, K; Ramsey, SD
Published in: J Oncol Pharm Pract
June 2022

BACKGROUND: Polypharmacy raises the risk of drug-drug interactions and adverse events among patients with cancer. Most polypharmacy research has focused on adults age 65 or older enrolled in Medicare insurance. To better inform pharmacy practice and cancer care delivery, data are needed on polypharmacy among commercially insured patients with cancer and those younger than 65. METHODS: We performed a retrospective analysis of insurance enrollment and claims files linked to the Puget Sound Cancer Surveillance System for adults age 18 and older who were commercially insured, diagnosed with stage IV cancer, survived 30+ days after diagnosis, and did not enroll in hospice. We describe the prevalence of polypharmacy, chemotherapy use, and medication-related out-of-pocket (OOP) costs in the last month of life. RESULTS: Of 606 patients, 390 (64%) experienced polypharmacy (i.e. 5+ medications) in the last 30 days of life. Almost half (n = 297, 49%) received chemotherapy or targeted agents; chemotherapy was associated with significantly higher odds of polypharmacy (odds ratio (OR) 2.93, 95% confidence interval (CI) 2.04-4.20). The most commonly prescribed medications at end of life were opioids, benzodiazepines and anti-emetics. Among 484 patients (80%) incurring medication-related costs in the last month of life, median total OOP cost was $82 (interquartile range $30-$200). Seven patients (1%) had total costs above $5,000. The median chemotherapy-related OOP cost was $446 (IQR $150-$1896); 32 patients (7%) had chemotherapy-related OOP costs between $1,000 and $5,000. CONCLUSION: Most patients with advanced cancer experienced polypharmacy at end of life, although most medications observed herein are commonly used for supportive care. Patients receiving chemotherapy had higher medication-related OOP costs, and chemotherapy was significantly associated with polypharmacy at end of life. Evaluation of polypharmacy at end of life may represent an important opportunity to improve quality of life and reduce costs for patients and families.

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Published In

J Oncol Pharm Pract

DOI

EISSN

1477-092X

Publication Date

June 2022

Volume

28

Issue

4

Start / End Page

836 / 841

Location

England

Related Subject Headings

  • United States
  • Retrospective Studies
  • Quality of Life
  • Polypharmacy
  • Oncology & Carcinogenesis
  • Neoplasms
  • Medicare
  • Humans
  • Health Expenditures
  • Death
 

Citation

APA
Chicago
ICMJE
MLA
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McDermott, C. L., Curtis, J. R., Sun, Q., Fedorenko, C., Kreizenbeck, K., & Ramsey, S. D. (2022). Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract, 28(4), 836–841. https://doi.org/10.1177/10781552211006180
McDermott, Cara L., J Randall Curtis, Qin Sun, Catherine Fedorenko, Karma Kreizenbeck, and Scott D. Ramsey. “Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer.J Oncol Pharm Pract 28, no. 4 (June 2022): 836–41. https://doi.org/10.1177/10781552211006180.
McDermott CL, Curtis JR, Sun Q, Fedorenko C, Kreizenbeck K, Ramsey SD. Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract. 2022 Jun;28(4):836–41.
McDermott, Cara L., et al. “Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer.J Oncol Pharm Pract, vol. 28, no. 4, June 2022, pp. 836–41. Pubmed, doi:10.1177/10781552211006180.
McDermott CL, Curtis JR, Sun Q, Fedorenko C, Kreizenbeck K, Ramsey SD. Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract. 2022 Jun;28(4):836–841.

Published In

J Oncol Pharm Pract

DOI

EISSN

1477-092X

Publication Date

June 2022

Volume

28

Issue

4

Start / End Page

836 / 841

Location

England

Related Subject Headings

  • United States
  • Retrospective Studies
  • Quality of Life
  • Polypharmacy
  • Oncology & Carcinogenesis
  • Neoplasms
  • Medicare
  • Humans
  • Health Expenditures
  • Death