A staggering number of Australian colorectal cancer survivors are grappling with polypharmacy, a situation researchers are calling 'deeply concerning'.
It's a complex issue, and understanding it is crucial for improving the lives of those who have battled and overcome colorectal cancer (CRC). This groundbreaking Australian research sheds light on just how prevalent polypharmacy is among CRC patients and pinpoints which individuals are more susceptible to being on multiple medications simultaneously.
Colorectal cancer stands as one of Australia's most prevalent cancers. What's particularly interesting is how CRC patients' medication regimens evolve throughout their cancer journey. Often, they find themselves managing a cocktail of different drugs at the same time. While studies in other patient groups, like those undergoing surgery or chemotherapy, have already established links between polypharmacy and a heightened risk of taking medications incorrectly, experiencing adverse effects, and even mortality, the situation for CRC survivors after their active treatment has been less clear.
But here's where it gets controversial...
To fill this knowledge gap, a team of Australian researchers embarked on a comprehensive, population-based study. They meticulously examined medication use in the year leading up to a CRC diagnosis, throughout the active treatment phase, and extending up to five years post-diagnosis. The findings were quite striking: over 70% of CRC patients experienced polypharmacy at some point during the study period. Even more telling, nearly 50% were still dealing with polypharmacy between years two and five after their diagnosis.
"Our study revealed that medication use doesn't simply revert to pre-cancer levels after diagnosis and primary treatment," the researchers explained in The Oncologist. "Instead, we observed an increased reliance on analgesic (pain-relieving) and psychotropic (mood-altering) medications over time." They emphasize that quality survivorship care must proactively address the unique challenges survivors face, such as persistent nerve pain (neuropathy), chronic pain, or psychological distress, and crucially, prioritize the prevention and management of non-cancer-related health issues (comorbidities).
To conduct this in-depth analysis, the researchers leveraged the Medicines Intelligence Data Platform. This sophisticated system integrates electronic health records for all adults in New South Wales, linking them with dispensing data from the Pharmaceutical Benefits Scheme, hospital admission records, cancer-specific information from the NSW Cancer Registry, and mortality data from the National Death Index. This powerful combination allowed them to paint a detailed picture of medication use in CRC patients.
The study identified 19,056 adults diagnosed with CRC over a five-year span. These patients were categorized by disease stage: 6,797 (35%) with localized disease, 8,482 (45%) with regional disease, and 3,777 (20%) with metastatic disease. Unsurprisingly, survival rates varied by stage, with five-year survival rates of 87% for localized and 78% for regional disease, compared to a significantly lower 27% for metastatic disease.
And this is the part most people miss...
The proportion of patients experiencing polypharmacy – defined as using five or more medications concurrently for at least a 90-day period around their diagnosis – was remarkably similar across all disease stages: 74% in the localized group, 79% in the regional group, and 79% in the metastatic group.
Interestingly, the number of medications dispensed per patient actually increased in the first 12 months following a CRC diagnosis. During this critical period, 30% of those with localized disease, 37% with regional disease, and 38% with metastatic disease were prescribed at least 10 unique medications.
Prior to their CRC diagnosis, certain groups were more likely to be on multiple medications. These included females, individuals aged 75 and older, patients with existing comorbidities, and those from more socioeconomically disadvantaged areas. This contrasts with younger patients, those without comorbidities, and individuals from more affluent backgrounds.
Similarly, in the years between the fourth and fifth year after diagnosis, age, the presence of comorbidities, and socioeconomic disadvantage continued to be strong predictors of increased polypharmacy.
"To our knowledge, this is the first study to explore polypharmacy in Australians with CRC," the researchers proudly stated. "Our findings underscore that medication use is not static; the number of dispensed medicines surged for our cohort in the year following diagnosis, likely coinciding with primary cancer therapies, before returning to pre-diagnosis levels for the majority."
They further noted that the types of medications dispensed also shifted post-diagnosis, with a notable increase in supportive drugs like antiemetics (to combat nausea), painkillers, and antidepressants. Crucially, opioids, other analgesics, and antidepressants remained among the most frequently dispensed medications throughout the survivorship period, even after active treatment concluded.
Now, let's discuss the elephant in the room. For patients treated with the goal of a cure, these higher-than-expected rates of polypharmacy are particularly troubling. They strongly suggest excessive illness and a diminished quality of life for survivors who have beaten cancer but continue to experience poorer health outcomes compared to the general population. Is it fair that those who have overcome such a significant battle still face these ongoing health challenges? What more can be done to ensure their post-cancer lives are as healthy and fulfilling as possible? Let us know your thoughts in the comments below!
