Medication regimen complexity in cancer patients: an overlooked issue for healthcare team

The primary aim of this study was to assess the medication regimen complexity in patients with cancer and the change in complexity from admission to discharge. The secondary aim of the study was to explore the impact of medication complexity on the length of hospital stay, patients' perceived medication burden, adherence, and unplanned hospitalizations after discharge.

This study was prospectively conducted in medical oncology clinics of a tertiary care hospital. Patients over 18 years of age and diagnosed with solid tumors and deemed non-palliative were included. A clinical pharmacist assessed the patient's medication regimen complexity using the medication regimen complexity index (MRCI) upon admission, at 48 h of hospitalization, and at discharge. The clinical pharmacist also participated in the patient education provided by the multidisciplinary team at discharge. Patients' adherence was assessed by the medication adherence reporting scale (MARS) at admission and at the first outpatient visit after the discharge. The perceived burden of drug treatment by the patients was assessed using a questionnaire named the medication complexity questionnaire from patient perspective (MCQPP) that was designed by the researchers. The questionnaire was administered at the first follow-up visit at the outpatient clinic after the discharge. Unplanned hospitalizations of the patients within 30 days after discharge were also examined.

A total of 147 patients were enrolled. The median (IQR) MRCI score at discharge was 15.0 (11.0-22.0), which was significantly higher than the MRCI score at admission, which was 11.0 (7.0-15.0) (p < 0.001). As a result of the patient education provided at discharge by the multidisciplinary team, a statistically significant increase was observed in the treatment adherence of the patients. The median (IQR) MARS score assessed at admission was 19 (15-23), while it increased to 20 (16-23) at the follow-up outpatient visit (p = 0.003). Complexity was found to be higher in patients who had more negative perceptions about their medication, in patients who reported that their daily life was significantly affected by their medication, and in those who perceived more significant burden when complex instructions for medication use were evident (p < 0.001). The median MRCI scores at discharge were higher in patients with unplanned hospitalizations compared to those without hospitalization (p < 0.001).

In conclusion, integrating the MRCI into oncology practices, along with multidisciplinary care that includes clinical pharmacists, may enable the identification of high-risk patients, the individualization of drug treatment, and the optimization of the treatment process.