Cancer, chronic conditions, and comorbidities often lead to polypharmacy. What is it, and what should oncology navigators know about helping their patients manage it?
Left to right: Billie Lynn Allard, RN, MSN, FAAN; Jennifer Edwards, BSN, RN, OCN, LSSGB; Mary Anderson, BSN, RN, OCN; and Ginger Blackmon, PharmD.
Polypharmacy, the regular use of at least 5 medications by patients, has become a complex issue, particularly in the field of oncology. Patients with chronic conditions and comorbidities often face the challenge of managing various medications to treat these conditions alongside their cancer treatments, and many of them are attempting to juggle it all on their own.
The complexity of these multiple medication regimens can create a tremendous burden for patients, but enhancing coordination among providers and increasing patient education can help to reduce polypharmacy-related complications and improve patient outcomes.
At the 2023 AONN+ Midyear Conference in Orlando, a panel of experts explored the challenges posed by polypharmacy in oncology and discussed management strategies for navigators and the entire multidisciplinary care team.
Challenges in Polypharmacy Management
Dealing with polypharmacy in oncology is complex for a number of reasons: patients may arrive to the cancer center with a significant medical history, multiple chronic diseases, and numerous medications from various sources. While some develop these chronic conditions prior to their cancer diagnosis, others develop these issues as a result of their cancer therapies.
Undergoing cancer treatment further compounds the management of chronic diseases, and the involvement of multiple providers, pharmaceutical companies, and medication sites adds to the intricacy of medication management. In addition, the lack of sufficient education about the challenges and potential dangers of polypharmacy only exacerbates the substantial burden placed on patients.
According to Ginger Blackmon, PharmD, assistant director of clinical initiatives at the National Community Oncology Dispensing Association, the potential consequences of polypharmacy in oncology include medication errors, poor adherence, drug-drug interactions, chemotherapy toxicity, higher pill burden, suboptimal postoperative outcomes, and negative clinical outcomes overall.
“So many of us help manage medications for family members, neighbors, or friends,” noted Billie Lynn Allard, RN, MSN, FAAN, administrative consultant for Population Health and Transitions of Care at Southern Vermont Health Care. “We have trouble doing that even as nurses, so I think it becomes a chronic anxiety in our specialty: wondering how people are handling [polypharmacy] without a family member or neighbor who’s a nurse.”
As part of an exercise at her center, nurses were partnered with primary care providers to follow high-risk chronic care patients across the care continuum to see how patients were actually managing their medications.
She says what they found was “terrifying.” It wasn’t unusual for patients to have their medications in the wrong bottles, to have several different medications in 1 bottle, to be taking discontinued medication because it was free from Medicare, or to have several conflicting medication lists from 3 or 4 providers.
“It was worse than we had imagined,” she said. “They had medications from the past 15 or 20 years from their friends or family members. Many of them were overwhelmed and asking us what to do with all of it.”
This approach allowed Ms Allard and her colleagues to gain a comprehensive understanding of patients’ medication management challenges and to identify some important roadblocks.
For example, some patients weren’t picking up their medications because they didn’t have transportation, which was leading to readmissions and emergency room visits. “And some patients had so many medications that they weren’t willing to take all of them,” she added. “They were picking and choosing which of those medications they were going to take, but they weren’t being truthful about it to their doctors and nurses.”
Solutions to Polypharmacy Challenges
According to Dr Blackmon, proactive financial navigation, including co-pay cards, foundation support, and patient assistance programs, can help improve medication access and affordability, while advocacy and legislation efforts are critical in reducing medication costs and increasing access. Routine patient outreach, patient education resources (such as oral chemotherapy education sheets), and tools like pill calendars can also aid in promoting patient adherence and understanding.
Regular medication reconciliation in the electronic health record by the entire medically integrated practice team is a vital step in reducing polypharmacy challenges; involving physicians, advanced practice providers, pharmacists, nurses, and navigators in open discussions about all medications being taken can enhance patient safety and reduce clinical fragmentation.
Telehealth and telepharmacy have also emerged as valuable tools (particularly post-COVID), providing increased accessibility and convenience for patients, especially in terms of clinic access and transportation challenges.
Fostering an open and nonjudgmental environment where patients feel comfortable disclosing their use of over-the-counter medications, supplements, and herbal remedies is also crucial. Utilizing resources like the Memorial Sloan Kettering app “About Herbs” helps identify potential drug-drug interactions, particularly in chemotherapy treatments, Dr Blackmon noted. “It’s important to just ask,” she added. “It’s amazing how patients simply haven’t been asked about what they’re taking.”
Regular medication reconciliation in the electronic health record by the entire medically integrated practice team is a vital step in reducing polypharmacy challenges.
The challenges of polypharmacy are multifactorial, involving an aging population with multiple chronic conditions, utilization of multiple providers and pharmacies, and patient hoarding. But ensuring effective coordination and communication among the entire multidisciplinary care team, in addition to increasing patient understanding of the topic, are essential in reducing polypharmacy challenges.
