AN EXAMINATION OF THE CAUSES AND CONSEQUENCES OF POLYPHARMACY AMONG ELDERLY PATIENTS WITH CANCER RECEIVING RADIOTHERAPY AT THE NATIONAL HOSPITAL, ABUJA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Polypharmacy, typically characterised by the concurrent use of five or more medications, presents a growing concern among older adults, particularly those dealing with chronic conditions like cancer (Maher, Hanlon, & Hajjar, 2014; Masnoon, Shakib, Kalisch-Ellett, & Caughey, 2017; Gnjidic, Hilmer, Blyth, Naganathan, & Cumming, 2012; Hajjar, Cafiero, & Hanlon, 2007). With the increase in life expectancy and the progress in medical science providing a wider array of therapeutic options, the older demographic frequently experiences a range of treatments for various comorbid conditions. In the realm of cancer care, especially among individuals undergoing radiotherapy, the occurrence of polypharmacy is significant. This arises from the necessity to address not only the primary illness but also the various side effects associated with treatment, such as pain, nausea, and fatigue (Maher et al., 2014; Masnoon et al., 2017; Jyrkkä, Enlund, Korhonen, Sulkava, & Hartikainen, 2009; Morin, Johnell, Laroche, Fastbom, & Wastesson, 2018). In the setting of the National Hospital in Abuja, where elderly cancer patients undergo extensive treatments such as radiotherapy, it is essential to comprehend the causes and effects of polypharmacy to enhance patient care and elevate health outcomes.

The elevated prevalence of polypharmacy in elderly cancer patients can be attributed to various elements, such as the treatment of cancer-associated symptoms, existing comorbid conditions, and adverse effects stemming from radiotherapy (Rieckert et al., 2018; Maher et al., 2014; Gnjidic et al., 2012; Fried et al., 2011). With advancing age, these individuals frequently encounter a range of health issues, including hypertension, diabetes, and cardiovascular diseases, which require the administration of multiple medications, each aimed at addressing particular symptoms or underlying disease mechanisms. In the realm of cancer care, especially concerning radiotherapy, the intricacies of polypharmacy escalate as supplementary medications are introduced to address pain, inflammation, and nausea (Morin et al., 2018; Masnoon et al., 2017; Jyrkkä et al., 2009; Kantor, Rehm, Haas, Chan, & Giovannucci, 2015). The intricacies involved heighten the potential for drug interactions, which may undermine the efficacy of cancer therapies and lead to negative health consequences in older patients.

The use of multiple medications in older cancer patients profoundly affects their quality of life and health outcomes. Studies indicate a heightened risk of adverse drug reactions, drug-drug interactions, and subsequent hospitalisations (Gnjidic et al., 2012; Masnoon et al., 2017; Maher et al., 2014; Fried et al., 2011). Adverse drug reactions pose significant challenges for elderly patients receiving radiotherapy, given that their compromised immune systems and pre-existing comorbidities may intensify the side effects associated with various medications. Moreover, the phenomenon of polypharmacy may result in “prescribing cascades,” wherein supplementary medications are administered to address side effects induced by other drugs, thereby sustaining a cycle of heightened medication consumption (Jyrkkä et al., 2009; Kantor et al., 2015; Rieckert et al., 2018; Maher et al., 2014). Research indicates that the use of multiple medications is linked to decreased adherence to treatment plans, cognitive decline, and a heightened risk of falls and fractures, thereby complicating the management of older cancer patients (Masnoon et al., 2017; Morin et al., 2018; Fried et al., 2011; Gnjidic et al., 2012).

In addition to the complications arising from adverse drug interactions, the issue of polypharmacy introduces considerable difficulties regarding medication adherence and the overall safety of patients (Fried et al., 2011; Rieckert et al., 2018; Maher et al., 2014; Masnoon et al., 2017). Elderly patients often face challenges in adhering to complex medication regimens, resulting in potential missed doses or overdoses due to difficulties in recalling dosing schedules. The phenomenon of cognitive decline, frequently observed in older adults, presents additional challenges to adherence, especially among cancer patients who are navigating the significant physical and emotional burdens imposed by their condition and its associated therapies (Hajjar et al., 2007; Morin et al., 2018; Maher et al., 2014; Gnjidic et al., 2012). Furthermore, failure to follow prescribed medication regimens, stemming from factors such as confusion, financial limitations, or a perceived lack of necessity, can result in less than ideal treatment outcomes, heightened rates of hospitalisation, and an overall decline in health status among this at-risk group (Masnoon et al., 2017; Rieckert et al., 2018; Fried et al., 2011; Maher et al., 2014).

Beyond the complications related to physical health, the issue of polypharmacy among elderly cancer patients presents significant challenges in clinical management and healthcare expenditures. The allocation of time and resources necessary for the monitoring, management, and adjustment of various medications leads to heightened healthcare expenses, affecting both patients and healthcare systems (Rieckert et al., 2018; Jyrkkä et al., 2009; Morin et al., 2018; Kantor et al., 2015). Furthermore, older individuals frequently encounter difficulties with the intricacies of their medication schedules, resulting in challenges such as incorrect dosing and noncompliance, which can adversely affect their overall treatment results (Gnjidic et al., 2012; Fried et al., 2011; Masnoon et al., 2017; Maher et al., 2014). The challenge of polypharmacy also falls upon healthcare providers, who are tasked with weighing the advantages of various medications against their possible adverse effects. This is especially critical in the context of radiotherapy, where the side effects of drugs can significantly impact the effectiveness of cancer treatment and the survival of patients.

The management of polypharmacy in elderly cancer patients is further complicated by the healthcare system’s approach to medication prescription, which is often marked by insufficient comprehensive medication review practices (Maher et al., 2014; Morin et al., 2018; Gnjidic et al., 2012; Hajjar et al., 2007). Polypharmacy may arise when various specialists, including oncologists, cardiologists, and primary care physicians, prescribe medications independently, resulting in overlapping or contradictory prescriptions (Fried et al., 2011; Masnoon et al., 2017; Morin et al., 2018; Gnjidic et al., 2012). The absence of cohesive care frequently leads to insufficient oversight of medication protocols, which may result in adverse consequences for the patient. Enhancing communication among healthcare providers and conducting regular medication reviews are approaches that may alleviate certain challenges associated with polypharmacy in cancer care (Maher et al., 2014; Morin et al., 2018; Fried et al., 2011; Gnjidic et al., 2012).

Considering these challenges, there is an increasing acknowledgement of the necessity to create and execute strategies designed to reduce the adverse effects of polypharmacy in elderly cancer patients (Rieckert et al., 2018; Maher et al., 2014; Gnjidic et al., 2012; Hajjar et al., 2007). Approaches like deprescribing, which involves the systematic discontinuation of unnecessary medications, have demonstrated potential in alleviating medication burden and enhancing health outcomes among elderly patients (Morin et al., 2018; Fried et al., 2011; Masnoon et al., 2017; Jyrkkä et al., 2009). Furthermore, offering targeted training for healthcare professionals in the management of polypharmacy, especially within the fields of oncology and geriatrics, may improve their capacity to critically evaluate the necessity of each medication and prioritise treatments that provide the greatest benefit to the patient (Maher et al., 2014; Rieckert et al., 2018; Gnjidic et al., 2012; Masnoon et al., 2017).

In light of the increasing recognition of the dangers associated with polypharmacy, there remains a notable deficiency in research specifically targeting elderly cancer patients receiving radiotherapy. This study seeks to fill that void. Radiotherapy serves as a crucial element in the management of cancer, with the potential to amplify the consequences of polypharmacy, given that the body's reaction to radiation is shaped by the medications being taken simultaneously (Fried et al., 2011; Masnoon et al., 2017; Morin et al., 2018; Jyrkkä et al., 2009). Comprehending the distinct causes and effects of polypharmacy within this patient demographic may assist healthcare professionals in formulating more precise interventions and guidelines aimed at enhancing patient outcomes. This investigation at the National Hospital, Abuja, aims to provide significant understanding of the impact of polypharmacy on elderly cancer patients within the Nigerian healthcare framework, and how these findings could shape future policies and practices in cancer care.

1.2 Statement of the problem

Polypharmacy is notably common among older cancer patients receiving radiotherapy, given their frequent coexisting chronic conditions and significant symptom burdens (Fried et al., 2014; Maher et al., 2014; Gnjidic et al., 2012). In environments such as the National Hospital, Abuja, where cancer treatment necessitates a collaborative approach, the dangers linked to polypharmacy can escalate notably, particularly in older patients with diminished physiological capabilities (Jyrkka et al., 2012; Hajjar et al., 2007; Salazar et al., 2007). The presence of multiple medications in these patients significantly increases the risk of adverse drug interactions and complicates the management of their treatment. This complexity often results in lower adherence rates and diminished therapeutic outcomes (Qato et al., 2008; Fick et al., 2011; Moriarty et al., 2016). The limited availability of geriatric specialists in numerous hospitals intensifies these challenges, thereby heightening the risk of inappropriate medication usage (Charlesworth et al., 2015; Kaufman et al., 2015; Fried et al., 2014).

The factors contributing to polypharmacy in elderly cancer patients are diverse, encompassing the prevalence of multiple comorbidities and the intricate nature of symptom management throughout the course of radiotherapy (Maher et al., 2014; Gnjidic et al., 2012; Jyrkka et al., 2012). Patients in this category often necessitate pharmacological interventions for pain relief, management of chemotherapy-related adverse effects, and various other health complications. This situation can result in the administration of five or more different medications, consequently heightening the potential for drug-drug interactions (Fried et al., 2014; Fick et al., 2011; Qato et al., 2008). The complexity of this issue is further exacerbated by the tendency of cancer treatment guidelines to emphasise symptom management, often lacking sufficient direction regarding safe medication limits. This oversight leads to an increased burden of medication (Moriarty et al., 2016; Hajjar et al., 2007; Salazar et al., 2007). Furthermore, insufficient communication among healthcare providers can lead to elderly patients receiving overlapping prescriptions, which in turn heightens the complexity and risks linked to polypharmacy (Charlesworth et al., 2015; Maher et al., 2014; Kaufman et al., 2015).

The implications of polypharmacy in older cancer patients are extensive, influencing their physical and mental well-being, and ultimately shaping the quality of life and effectiveness of treatment (Hajjar et al., 2007; Fick et al., 2011; Salazar et al., 2007). Older patients taking several medications face increased risks of negative drug interactions, falls, cognitive decline, and hospital admissions, all of which can greatly impact their outcomes during cancer therapy (Gnjidic et al., 2012; Qato et al., 2008; Moriarty et al., 2016). Moreover, the phenomenon of polypharmacy can impose significant demands on healthcare resources, as it often leads to a heightened necessity for hospital readmissions and further monitoring. These measures are frequently essential to address complications that may arise from adverse drug events (Charlesworth et al., 2015; Kaufman et al., 2015; Fried et al., 2014). Therefore, investigating the factors and effects of polypharmacy in elderly cancer patients at the National Hospital, Abuja, is crucial for guiding strategies that enhance medication management and elevate patient outcomes in this at-risk group. Thus, the necessity for the research arises.

1.3 Objectives of the study

The primary objective of this study is to examine the causes and consequences of polypharmacy among elderly patients with cancer receiving radiotherapy at the National Hospital, Abuja. Specific objectives of this study are to:

1. To identify the causes of polypharmacy among elderly cancer patients receiving radiotherapy at the National Hospital, Abuja

2. To investigate the consequences of polypharmacy on the health outcomes of elderly cancer patients undergoing radiotherapy

3. To examine the role of healthcare providers in managing polypharmacy among elderly cancer patients at the National Hospital, Abuja

4. To assess the challenges faced by elderly cancer patients in adhering to complex medication schedules during radiotherapy.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What are the causes of polypharmacy among elderly cancer patients receiving radiotherapy at the National Hospital, Abuja?

      2. What are the consequences of polypharmacy on the health outcomes of elderly cancer patients undergoing radiotherapy?

      3. What are the role of healthcare providers in managing polypharmacy among elderly cancer patients at the National Hospital, Abuja?

      4. What are the challenges faced by elderly cancer patients in adhering to complex medication schedules during radiotherapy?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Polypharmacy has no significant consequences on the health outcomes of elderly cancer patients undergoing radiotherapy at the National Hospital, Abuja

Ha: Polypharmacy has significant consequences on the health outcomes of elderly cancer patients undergoing radiotherapy at the National Hospital, Abuja

1.6 Significance of the study

The phenomenon of polypharmacy, marked by the concurrent use of various medications, is notably common within this demographic, stemming from the intricate challenges of addressing cancer symptoms in conjunction with other existing health issues. Comprehending the underlying reasons for polypharmacy in this scenario is crucial for pinpointing the elements that contribute to the overuse of medications, which may heighten the likelihood of adverse drug reactions and complicate treatment plans. The findings from this study will equip healthcare professionals with the essential understanding required to evaluate and address the risks linked to polypharmacy, ultimately promoting patient safety and optimising the effectiveness of cancer treatment. Moreover, this analysis will shed light on the distinct obstacles encountered by older patients in following intricate medication regimens, ultimately resulting in enhanced medication management approaches customised to their requirements. This research will establish a foundational reference for healthcare practitioners, policymakers, and others in the field.

Healthcare professionals, such as oncologists, chemists, and nursing staff, are essential participants who will gain insights from the outcomes of this study. By gaining a deeper insight into the causes and consequences of polypharmacy, these professionals are better equipped to take a more proactive stance in assessing and prescribing medications for elderly cancer patients. The research highlights the significance of collaborative efforts among healthcare professionals to facilitate thorough medication evaluations and integrated care strategies that encompass both cancer therapies and the management of concurrent health issues. Furthermore, the investigation could result in the creation of educational initiatives designed to improve healthcare practitioners' understanding of the dangers associated with polypharmacy, thereby empowering them to engage in more effective dialogues with patients regarding their medication plans and possible interactions. Enhanced understanding and effective communication can lead to increased adherence rates and improved health outcomes for elderly patients undergoing radiotherapy.

This research holds considerable importance for those in positions of authority and management within the healthcare sector, particularly in the formulation of guidelines and regulations related to medication management in oncology care. The results will offer substantial evidence that can guide policy decisions focused on decreasing the prevalence of polypharmacy in elderly cancer patients. It is essential for those in positions of authority to establish uniform guidelines for the evaluation of medications, thereby enabling healthcare professionals to adeptly navigate the intricacies associated with polypharmacy. The findings of this study underscore the critical need for resources and training initiatives aimed at informing healthcare professionals about the ramifications of polypharmacy in oncology, thereby fostering safer practices in medication prescribing and management.

This study will be of great significance to organisations dedicated to cancer care and the health of the elderly. The results can guide their outreach initiatives, enhancing awareness among patients and carers regarding the dangers linked to polypharmacy. These organisations can utilise the research to create focused educational resources and workshops that enable elderly patients and their families to participate in meaningful conversations with healthcare providers about their medications. Furthermore, the findings from this research can bolster efforts to promote enhanced access to comprehensive cancer care services, guaranteeing that older patients obtain the essential assistance needed to manage the intricacies of polypharmacy during their treatment. This research aims to enrich the ongoing dialogue surrounding the improvement of healthcare delivery and safety for elderly patients with cancer, providing advantages to various stakeholders within the healthcare system.

This research presents notable benefits for both learners and investigators, delivering crucial information concerning polypharmacy. This study offers significant perspectives for learners in health-related fields, tackling the complex challenges associated with the management of polypharmacy in elderly populations. It highlights the importance of comprehending real-world challenges and the essential role of empathy and patient education within the healthcare process. The results of this research lay the groundwork for additional investigation into issues related to polypharmacy and can act as a reference point for comparative studies across various geographic or demographic settings. This research lays the groundwork for future enquiries aimed at discovering effective strategies and policies to tackle polypharmacy, thus contributing to the academic discourse on healthcare management for older adults. This study has the potential to be an invaluable resource for policymakers in developing guidelines and policies that improve safe medication practices and enhance healthcare accessibility and support for elderly patients, thereby extending its significance beyond National Hospital, Abuja to similar healthcare institutions across Nigeria.

1.7 Scope of the study

Broadly, this study focus is to critically examine the causes and consequences of polypharmacy among elderly patients with cancer receiving radiotherapy in Nigerian hospitals. Empirically, the study will explore the causes of polypharmacy among elderly cancer patients receiving radiotherapy in Nigerian hospitals, the consequences of polypharmacy on the health outcomes of elderly cancer patients undergoing radiotherapy in Nigerian hospitals, the role of healthcare providers in managing polypharmacy among elderly cancer patients in Nigerian hospitals and the challenges faced by elderly cancer patients in adhering to complex medication schedules during radiotherapy in Nigerian hospitals

Geographically, the study will be carried out at the National Hospital, Abuja.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an examination of the causes and consequences of polypharmacy among elderly patients with cancer receiving radiotherapy at the National Hospital, Abuja. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around the National Hospital, Abuja. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Polypharmacy: Polypharmacy is generally defined as the concurrent use of multiple medications by a patient,

Medication: Medication is a dosage form that contains one or more active and/or inactive ingredients. Medications come in many dosage forms, including tablets, capsules, liquids, creams, and patches. They can also be given in different ways, such as by mouth, by infusion into a vein, or by drops that are put into the ear or eye

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