MedicalResearch.com Interview with:
Dr. Catherine S. M. Diefenbach MD
Assistant Professor of Medicine
NYU Cancer Center
New York, NY 10016
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Diefenbach: It is well known that age is important prognostic factor in non-Hodgkin’s lymphoma (NHL). Multiple studies have illustrated that elderly lymphoma patients have inferior survival outcomes as compared to their younger counterpart. While the tumor biology is often different in these two groups, and may play a role in this discordancy, elderly patients are often frail or have multiple medical comorbidities. These include geriatric syndromes, such as: cognitive impairment, falls, polypharmacy, and potentially inappropriate medication (PIM) use. All of these may contribute to poor outcomes for elderly patients. In addition, elderly patients are often under-treated for their aggressive lymphoma out of concern for toxicity or side effects, even though the data clearly demonstrates that elderly patients can still benefit from curative intent chemotherapy.
MedicalResearch.com: What should readers take away from your report?
Dr. Diefenbach: In the group of 246 elderly non-Hodgkin’s lymphoma patients that we analyzed who were treated at NYU between 2009 and 2014, almost half of these patients used more than 4 medications at the time of diagnosis and used at least one potentially inappropriate medication. Increased numbers of medications and potentially inappropriate medication, correlated with shortened progression free and overall survival. Moreover, there is a strong positive correlation between the number of medications and PIM used and the incidence of treatment-related toxicities of grade 3 or higher.
Mechanistically, polypharmarcy and potentially inappropriate medication use likely contribute to significant drug-drug interactions during intensive chemotherapy leading to poor outcome. This work suggests that meticulous medication management during intensive chemotherapy may improve outcome for elderly lymphoma patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Diefenbach: We are in the process of validating these results using an independent cohort of elderly patients. Additionally, we are designing a targeted intervention of geriatric co-management during intensive chemotherapy treatment for elderly non-Hodgkin’s lymphoma patients, which we plan to test in a pilot study with the end-points of improving adequate chemotherapy delivery and reducing treatment-related toxicities.
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Citation: 2016 ASCO abstract:
Adverse impact of polypharmacy and potentially inappropriate medication use in newly diagnosed, elderly lymphoma patients.
Citation: J Clin Oncol 34, 2016 (suppl; abstr 6562)
Author(s): Richard Jirui Lin, Robin Guo, Daniel Jacob Becker, Michael L. Grossbard, Catherine S. Magid Diefenbach; NYU Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY; New York University Medical Center, New York, NY; New York University Perlmutter Cancer Center/New York University School of Medicine, New York, NY
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