The polypharmacy problem

Taking multiple different medications without proper medical supervision can cause more harm than good. You don’t have to do this alone.

Key Messages

  • Taking more medications or supplements does not necessarily mean more benefit. Even the most common medicines and supplements can have potentially serious side-effects or can interact dangerously with other drugs, especially in the context of cancer.
  • The risk of serious side-effects increases with every extra medication taken.
  • At the Care Oncology clinic we regularly see patients who have become unwell through taking unregulated supplements or prescription medications without proper medical supervision. That’s why we believe that full and proper medical oversight by qualified clinicians is so vital.
  • We also understand that as someone living with cancer, you want to help yourself as much as possible. We fully respect your right to do that.
  • At Care Oncology, our specialist clinicians and nurses are here to help you safely navigate your repurposed medications. We do not judge, and we are here to help. If you have any questions about your medications, or any safety worries at all, please do come to us.

Summary

Around 1 million patients end up in US hospitals every year as a result of using prescribed medications. Taking multiple medications, sometimes called polypharmacy, can increase risk of side effects, poor outcomes and even death. With each additional medication and supplement, the risk of adverse outcomes due to medication interactions is also increased. . This is why our specialist clinicians take extreme care when prescribing the Care Oncology protocol medications, and each patient is regularly monitored for potential issues.

Every day our clinic hears from patients who have encountered problems caused by taking other medications alongside the Care Oncology protocol, without proper medical supervision. Some have ended up in the ER because they have added an unregulated supplement alongside their usual Care Oncology regimen. Others have suffered severe symptoms such as internal bleeding or liver problems as a result of using regular prescription medications without proper monitoring.

Cancer medicine requires constant balancing of potential risks and benefits against an ever-changing background of disease. But we also understand that as someone living with cancer, you want to help yourself as much as possible. That’s why we are here to help you safely navigate your own complex situation. You don’t have to do this alone.

More medicines can mean more risk

Taking more medications does not necessarily mean more benefit. Mismanaged or unregulated polypharmacy is a significant driver of prescription drug-related hospitalizations, and research shows that the risk of having a drug-related health issue increases by 10% for every extra medication taken (Gandhi et al., 2003). A patient taking ten medications has twice the risk of death compared to a patient taking just one (Leelakanok et al., 2017). In the US, polypharmacy mismanagement is estimated to result in healthcare costs of at least $1.3 billion[1] every year, mostly due to inpatient care, visits to the ER and hospitalization as a result of complications and adverse side-effects. Put simply, if you take more medications, no matter how safe they are, you become much more likely to suffer a serious side-effect or drug-drug interaction as a result.

Even the most common medicines can have potentially serious side-effects, especially in the context of cancer. One reason for this is because both the disease and the standard-of-care treatments given can place body systems under extreme strain. The risk directly escalates with the number of medications used. Mild side-effects caused by just one medication can soon become problematic when several medications with the same or similar side-effects are used together.

Even painkillers carry risk

The widely used painkiller acetaminophen/Tylenol is invaluable in providing pain relief caused by cancer and cancer-related treatments. Yet this common medication can be toxic to the liver and fatal at high-doses – even in patients with no other health issues. In the context of cancer, extra care must be taken as acetaminophen is often used alongside chemotherapy drugs, which can also stress the liver and increase the risk of liver damage. Careful monitoring is required, even for this very common and very safe drug, to make sure the liver is not placed under undue strain.

Aspirin is another well-used analgesic, and some patients take this medication for its potential anticancer effects. However, aspirin can also cause severe internal bleeding if taken for too long, at the wrong dose, in combination with other medications, or with a background of certain health issues. At Care Oncology we regularly see patients who have become unwell from taking long-term or high-dose aspirin alongside their other cancer medications without medical supervision. Some of these patients have ended up in the ER.

Supplements are drugs too

Did you know that some types of supplements can cause toxic effects, or can interfere with your standard-of-care treatments and Care Oncology Protocol medications?

Any supplement which has an effect on the body will also have other side-effects, and can also potentially interact with other drugs too. And because many supplements are unregulated, these effects are not necessarily as well understood as for prescribed medications. We know of patients who have become unwell from taking supplements alongside their usual treatments and the Care Oncology Protocol. Common issues include:

  • Severe gastrointestinal side-effects or serious blood pressure issues which have required ER treatment as a result of taking berberine alongside other medications,
  • Liver problems caused by taking too much curcumin,
  • Life-threatening illness due to taking high-dose combinations of multiple supplements alongside other treatments.

We can help by providing information and advice; please do tell us every medication and supplement you are taking, so we can make sure we’re giving you the best medical supervision that we can. While nobody fully knows the effects, the side-effects and the interactions of every supplement, we may have encountered the situation before, or we may have knowledge of that supplement.

Appropriate medical advice is essential

We commonly see patients who have developed issues when using combinations of medications and supplements suggested online, which have then been prescribed by multiple doctors, or by non-specialist doctors who cannot provide cohesive oversight in the context of a patient’s condition. For example, we have had patients who suffer daily nosebleeds due to taking warfarin alongside anti-inflammatory medications such as dexamethasone. And we have seen others with an increased risk of seizures caused by taking medications which lower their seizure threshold, such as the anti‑malarial drug chloroquine and tricyclic antidepressants. This is an especially important issue in cancer patients with disease of the brain.

At Care Oncology, we use oncologists and oncology nurses for support because they fully understand the full context of your cancer, the complex treatments that go with it, and how to safely integrate medications. We are a group of open-minded clinicians who can help you safely navigate your repurposed medications. We do not judge, and we are here to help. If you have any questions about your medications, or any safety worries at all, please do come to us.

Some other common issues from our clinic

We understand the goal of wanting to defeat cancer and doing all you can in terms of treatments. Every day we manage issues which have arisen due to the challenge of taking numerous medications and supplements without the oversight of a specialized Care Oncology clinician. Some common safety issues we have encountered include:

  • Using out of date medications Out-of-date medicines can cause serious illness, we have even known of patients ending up in the ER, in part through taking expired medications.
  • Using medicines provided by family and friends We always recommend proper medical supervision, as only trained clinicians can fully understand your specific situation, and how best to help you.
  • Ordering counterfeit medications from countries where regulation is minimal. Medications ordered online may not be properly regulated, and without accountability, there is no way to be sure that what arrives is real and safe.
  • Taking veterinary medicines, or other drugs with little or no data in humans. Medications designed for animals are not tested for human use. Nobody knows exactly how these drugs will affect the human body, or how they will react in the presence of other medications. There is usually no need to take these medications, as there are always much safer, and more effective alternatives. For example, mebendazole is the human equivalent of the veterinary treatment fenbendazole. Both drugs have very similar mechanism of action, but mebendazole has passed extensive safety and effectiveness checks and has been licensed for use in humans. There is also more anticancer data for mebendazole than there is for fenbendazole.

Why do we take patient safety so seriously?

At Care Oncology our overall aim is to repurpose certain already licensed and common medications to help treat cancer. But managing patient safety in this context comes with special responsibilities.

We know people with cancer must live with very specific, often very complex conditions, and are often already undergoing treatments that may be difficult to tolerate.. Maintaining overall patient safety and comfort is very important to us, and we take it very seriously.

When we developed the Care Oncology Protocol, we deliberately chose only those medications which are supported by huge amounts of safety data garnered from years of clinical use. And this is also one reason why we don’t prescribe other medications, which might not have the same level of safety data supporting their use. We also don’t recommend the unsupervised addition of other medications and supplements to the Care Oncology Protocol regimen without having a full understanding of all potential risks.

Our expert oncologists are on your side

Our oncologist and specialist nurses are here to care for you, here to help and guide you through every step of this particularly difficult and confusing time. We will stay with you, talk to you, and give you honest advice, without judgement. We will also not prescribe anything that we think is not in your best interests. We want to help you get the best outcome you can, while also staying safe.

No drug is completely risk-free. Even the Care Oncology Protocol medications have some well-defined safety flags which our oncology team know how to monitor, and can address appropriately should they ever arise. The vast majority of patients (over 85%) who take the Care Oncology Protocol can take all four medications over the long-term without any issues. You can read more about our research safety data in our first scientific research paper, available online here. Our oncology nurses are also available to provide more information as well as to provide symptom management and problem solving for those taking the Care Oncology protocol.

The Care Oncology Protocol is so well tolerated in our patients for a number of reasons: because we understand these medications, because we fully monitor each patient and take care to understand each personal situation, because of the extensive data research we carried out when developing this specific combination, and last but not least, because of our own experience treating thousands of patients with these medications in our own clinic. We are building on this existing knowledge every day- crafting and refining how and when we treat our patients with different cancers, at different stages, and under different conditions.

If you have any questions around your care, or any other medications you are taking and how they might interact with the Care Oncology Protocol medications, please do get in touch with your Care Oncology Nurse and we will be very happy to help you.

References

Data from: Avoidable_Costs_in _US_Healthcare-IHII_AvoidableCosts_2013[1]_Pg27

Agrawal, S., Vamadevan, P., Mazibuko, N., Bannister, R., Swery, R., Wilson, S., and Edwards, S. (2019). A New Method for Ethical and Efficient Evidence Generation for Off-Label Medication Use in Oncology (A Case Study in Glioblastoma). Front. Pharmacol. 10.

Gandhi, T.K., Weingart, S.N., Borus, J., Seger, A.C., Peterson, J., Burdick, E., Seger, D.L., Shu, K., Federico, F., Leape, L.L., et al. (2003). Adverse Drug Events in Ambulatory Care. New England Journal of Medicine 348, 1556–1564.

Leelakanok, N., Holcombe, A.L., Lund, B.C., Gu, X., and Schweizer, M.L. (2017). Association between polypharmacy and death: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 57, 729-738.e10.

 

[1] Data from: Avoidable_Costs_in _US_Healthcare-IHII_AvoidableCosts_2013[1]_Pg27