(P-254) Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer

Background: As survivors of childhood cancer age, they develop cancer treatment-related chronic health conditions which might require lifelong medications.

Objectives: To describe the pattern of chronic prescription medication use and identify factors associated with polypharmacy among survivors of childhood cancer

Methods: This was a retrospective study conducted at the pediatric oncology clinic of a tertiary hospital in Hong Kong. Eligible survivors were diagnosed with cancer before the age of 19 years, and ≥3 years post-diagnosis, and had ≥1 month post-treatment. The electronic dispensing records were reviewed to identify medications prescribed to be taken daily for ≥30 days or used on a “prn” basis for ≥6 months cumulatively within the past 12-month period. Polypharmacy was defined as the concurrent use of ≥5 chronic medications. Multivariable log-binomial modeling was conducted to identify treatment and clinical factors associated with medication use pattern and polypharmacy.

Results: This study included 625 survivors (mean current age 17.9 years, standard deviation [SD] 7.2 years) who had completed cancer treatment 9.2 [5.2] years ago. Almost one-third (n=219, 35.0%) of the survivors were prescribed at least 1 chronic medication. The most commonly prescribed medication classes were systemic antihistamines (26.5%), sex hormones (19.2%), and thyroid replacement therapy (16.0%). Survivors were more likely to be prescribed sex hormones if they had undergone cranial radiation (adjusted risk ratio[RR] 14.15; 95% CI 6.20–32.39) and/or hematopoietic stem-cell transplantation (HSCT) (RR 10.22; 95% CI 5.12–20.38). The overall prevalence of polypharmacy was 5.3% (n=33). Higher prevalence of polypharmacy was observed in survivors aged more than 30 years (11.7%) than in survivors aged less than 30 years (4.5%–5.9%). A higher rate of polypharmacy was found in survivors of CNS tumors (13.6%) than in survivors of hematological malignancies (4.3%) and other solid tumors (5.3%) (P=.0051). Higher medication burden was also observed in survivors who developed at least 1 chronic condition (RR 7.35; 95% CI 3.45–15.66) and those who had cranial radiation (RR 6.31; 95% CI 2.75–14.49) or HSCT (RR 3.53; 95% CI 1.59–7.83).

Conclusions: Although polypharmacy was observed in only a minority of survivors of childhood cancer, chronic medication use was common in the overall cohort. Special attention should be paid to groups that are at a higher risk of developing treatment-related chronic health conditions that require pharmacological interventions. They should be monitored more closely for adverse health outcomes, particularly during hospitalization in an acute care setting.