Impact of Beers Criteria Medications in Elderly Patients With Head and Neck Cancer

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BACKGROUND: Head and neck cancer patients often experience polypharmacy due to complex treatments and comorbidities. The Beers Criteria is a list of potentially inappropriate medications (PIMs) for patients above age 65 developed by the American Geriatrics Society. We hypothesize that increased use of PIMs will be associated with inferior health and quality of life outcomes in elderly patients with head and neck cancer. METHODS: We retrospectively examined patients aged ≥ 65 years with head and neck cancer diagnosed between 2011 and 2015 using SEER-Medicare data, analyzing associations between Beers Criteria Medications (BCMs) and survival as a primary outcome. Emergency department (ED) utilization served as a secondary outcome. RESULTS: Among 5213 patients (mean age 72.6 years), 44% received no BCMs within 1 year of diagnosis, while 41.3% received 1 BCM, 9.3% received 2 BCMs, and 5.4% received ≥ 3 BCMs. The most common medications prescribed were Lorazepam (12.3%), Zolpidem (7.9%), and Alprazolam (7.5%). Two-year survival decreased with BCM use in a dose-dependent fashion: 88.2% (0 BCM), 86.8% (1 BCM), 86.7% (2 BCMs), and 81.4% (≥ 3 BCMs; p < 0.001). BCM users had higher ED utilization in the year after diagnosis (mean 1.21 vs. 0.95 claims, p = 0.004). CONCLUSIONS: BCMs in elderly head and neck cancer patients were associated with inferior survival and increased healthcare utilization. These findings highlight the need for medication reconciliation and systematic reviews by multidisciplinary care teams to optimize outcomes in this vulnerable population.

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