Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The Beers Criteria were developed by the American Geriatrics Society to identify potentially inappropriate medications for adults aged 65 and older because this population is at high risk for adverse drug events. Head and neck cancer patients often have numerous functional limitations and medical comorbidities, which leads to a high prevalence of polypharmacy. There is currently limited evidence regarding how the use of Beers Criteria medications in this population affects outcomes. We hypothesized that the increased use of Beers Criteria Medications to Avoid would be associated with worse outcomes in elderly patients with head and neck cancer.
Methods: This was a retrospective cohort study utilizing the SEER-Medicare data resource. Patients above age 65 who were diagnosed with head and neck cancer between 2011-2015 were included in our study. The 2023 Beers Criteria Medications to Avoid with at least moderate quality of evidence and strong strength of recommendation in the following categories were included: gastrointestinal (GI), pain, central nervous system (CNS), and antihistamine. Medications were excluded if the Beers Criteria recommendations allowed for their use for certain indications. Medications had to be used within one year after diagnosis of cancer and for at least 10 days. Patients with survival less than one year were excluded to address immortal time bias.
Results: A total of 5349 patients met the inclusion criteria. Mean age was 72.6 years (SD 9.2) and 33.0% were female. In total, 43.9% of patients were not prescribed any Beers Criteria medications (BCM) in the year after cancer diagnosis, 41.4% were prescribed 1, 9.3% were prescribed 2, and 5.4% were prescribed 3 or more. The most prevalent category of BCM was CNS (33.0% of patients) followed by pain (23.9%), antihistamine (5.9%), and GI (3.3%). The three most common medications were Lorazepam, Alprazolam, and Zolpidem. Two-year overall survival was 88.2% for 0 BCM, 86.8% for 1 BCM, 86.7% for 2 BCM, and 81.4% for 3+ BCM (p<0.001). Patients who were prescribed at least one BCM tended to be younger (age 71.43 vs 73.97, p<0.001), and were more likely to be female (36.7% vs. 28.3%, p<0.001) compared to those prescribed no BCM. Similarly, those in the 1+ BCM group were more likely to have received chemotherapy (39.3% vs 32.6%, p<0.001) or radiation (61.9% vs. 56.1%, p<0.001) and less likely to have received surgery (62.0% vs. 67.0%, p<0.001). Patients who received 1+ BCM had higher emergency department (ED) use in the year after diagnosis (average number of ED claims 1.21 vs. 0.97, p=0.004).
Conclusions: Over half of patients aged 65 and over with head and neck cancer were prescribed one or more Beers Criteria Medications to Avoid and 5.4% were prescribed three or more in the year following their cancer diagnosis. Increased prescription of Beers Criteria medications was associated with inferior overall survival and increased emergency department utilization. Further research regarding how to minimize the use of these medications in elderly patients with head and neck cancer is warranted.