Drug Interactions and Polypharmacy

Lung cancer is highly prevalent in senior adults. Older people are the greatest consumers of medications and healthcare resources in developed countries; this implies that patients are affected by different age-related conditions including one or more other serious chronic diseases, i.e., comorbidity, especially cardiovascular diseases, chronic obstruction pulmonary disease (COPD), or diabetes. Due to the presence of comorbidity, older adults are more likely to use an increased number of medications and at high risk for adverse drug events. Such condition is generally referred as “polypharmacy.” Cancer-related therapy, adding new medications for both active cancer treatment and supportive therapy, further increases the risk of polypharmacy. Older oncologic patients with multiple comorbidities are at risk for adverse drug events associated with polypharmacy and drug–drug interactions due to patients’ altered pharmacokinetic/pharmacodynamic status and the narrow therapeutic windows associated with antineoplastic agents. In clinical practice, it is difficult to separate the effects of cancer and its treatment or complications from the effects of comorbidity and polypharmacy. In response to this, geriatricians and oncologists have developed comprehensive geriatric assessment (CGA) tools for cancer patients. The CGA encompasses the evaluation of numerous clinical domains, including physical function, psycho-cognitive status, nutrition, social support, comorbidity, and in a minor percentage polypharmacy. CGA instruments are strongly recommended and predictive of mortality and morbidity for several chronic diseases and in different clinical settings. Cancer-specific CGA are currently being evaluated with the aim to individualize the treatment based on age-related conditions including comorbidity.