Potentially Inappropriate Medication Use and Cognition in Older Women with Breast Cancer

Presenter: Ginah Nightingale, PharmD, MBA, BCOP, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA

Co-Authors: Ancy George, MS, Thomas Jefferson University, Philadelphia, PA; Maysa Abu-Khalaf, MD, MBA, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; Misung Yi, PhD, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Kristine Swartz, MD, Thomas Jefferson University, Philadelphia, PA; Andrew Chapman, DO, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

BACKGROUND: Older women with breast cancer (aged ≥60 years) are at high risk for cognitive impairment based on age, the cancer itself, and pharmacologic treatments. Cognitive impairment reduces treatment adherence, compromises functional status, increases the risk of falls, increases hospitalizations, and degrades quality of life. Potentially inappropriate medication (PIM) use increases such risks, yet the literature on its prevalence and impact on cognition in older women with breast cancer is sparse and limited by antiquated criteria (Beers criteria, 2003-2012).

OBJECTIVES: To evaluate the prevalence of PIMs and medications with anticholinergic burden in older women with breast cancer using updated criteria, and to explore the associations between PIM use and anticholinergic burden, clinical factors (eg, cognition, comorbidities), and demographic variables.

METHOD: This prospective, 24-month pilot study enrolled 40 women with breast cancer, aged ≥60 years, from the ambulatory clinic at Sidney Kimmel Cancer Center during 2019 to 2021. PIM use was defined by the 2019 Beers criteria. The anticholinergic cognitive burden (ACB) scale was used to define ACB. The short Montreal Cognitive Assessment (s-MOCA) was used as a screening test; the trail making test (Part B) was used to assess executive function and processing speed; and the subjective memory assessment was used to report subjective complaints. Patient demographic and clinical variables were collected.

RESULTS: A total of 40 women were included in the baseline analysis. The mean age was 68 years (range, 60-87 years), 26 (65%) patients were white, 28 (70%) were non-Hispanic, 19 (48%) were married, and 33 (83%) had some college or graduated college. In all, 30 (75%) patients had early-stage disease, and 37 (93%) had an ECOG performance status score of ≤1. Overall, 23 (58%) patients reported subjective memory complaints and 18 (46%) patients screened positive on the s-MOCA with a score of <13 points. The mean number of medications was 10.8, including 5.8 prescriptions, 3.6 nonprescriptions, and 1.5 herbal medications. PIM use and anticholinergic burden were common, with 24 (60%) patients using at least 1 PIM, and 23 (58%) using a medication with an ACB score of ≥1. The most common PIMs were NSAIDs (N = 16 patients) and benzodiazepines (N = 8 patients). The baseline variables associated with cognitive impairment were a higher number of medications, PIM use, and ACB score.

CONCLUSION: PIM use, anticholinergic burden, and cognitive impairment were common in older women with breast cancer in this study. These data suggest that providers should be aware of overusing PIMs and ACB medications associated with causing cognitive harm. Future studies focused on PIM and ACB deprescribing interventions are needed to optimize the medications linked to cognitive health in this population.

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