1. < Head & Neck Cancer

Overmedication with cancer and other conditions

Posted by Maureen, Alumna Mentor @alpaca, Apr 17, 2018

A lot of us with cancer are getting older and have comorbidities (new word I have acquired on this journey), so a danger is that we need a lot of medications to control not only pain but blood pressure, thyroid etc. We can be caught up in a tangle of medications all with their side-effects and possibly interactions. Do you have any tips about how to manage this?

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

jodeej | @jodeej | Apr 22, 2018
In reply to @jaler "Mayo requires that you update your list of prescriptions they have on file each time you..." + (show)
@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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@jaler you can request it and yes I'm sure you'll be billed, but it is well worth it if you have concerns. An appointment was part of my husband's pre-transplant work-up.

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Gaybinator | @gaybinator | Apr 22, 2018

@lisakuehl Dialysis is one reason for drug doses to be adjusted. My husband was taking a multi-vitamin when he first started dialysis, and his first labs were waaaaaay off. He now takes a low dose of B & C after dialysis. Those are water-solvable vitamins, therefore they are removed by dialysis. I imagine there are many other reasons for adjusting doses of both Rx and OTC drugs.

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Mentor
Scott, Volunteer Mentor | @IndianaScott | Apr 23, 2018
In reply to @IndianaScott "Very interesting and useful thread there! Thanks @alpaca aka Maureen :-) In my wife's case she..." + (show)
@IndianaScott

Very interesting and useful thread there! Thanks @alpaca aka Maureen 🙂 In my wife's case she was on a constantly changing stream of medications as they struggled with the constantly altering effects of her tumor. Initially it was a tough balancing act between her neuro-oncologist at Mayo, her GP at home, and our pharmacist. Early on our pharmacist was a huge help until our local pharmacy was sold to a chain and it was never the same pharmacist twice. I cringe when I think back to how much time I wasted re-educating pharmacist after pharmacist on who my wife was, what her condition was, and why she was on the cocktail she was on at that specific time. Grr!

Then there was the issue of doctor vs doctor, which put Kramer vs. Kramer to shame! Finally after a grueling 'duel', where I felt as if I were some bizarre type of Second, the neuro-oncologist finally convenience our GP to get out of the mediations loop (other than to be informed of any changes in meds or dosages). One professional ego took a hit and the relationship never recovered, but it was for the good of my wife so I was happy to give up the relationship I had with the same GP.

My wife was on a medicinal cocktail of 32 doses a day. Keeping them straight required a spreadsheet to keep track of the time of day and doses. Luckily, once my wife went into home hospice, her nurse transferred all her meds to another smaller pharmacy with a more stable staff and who delivered. They worked together hand-in-glove. At this point her meds were often changing daily so it was crucial for there to be solid, knowledgeable communications between all the medical pros! This was also critical when we had to go from pill-tablet-capsule form to all liquids for her meds since the liquid form often caused them to act differently, on a different timeline, absorption rate, etc. Unfortunately for future patients in our area, this pharmacy was also swallowed by a national chain and no longer offers the same level of service.

With all the progress in technology I would think information sharing would be simpler regarding patients, their medications, and the providers involved. Hopefully this will improve quickly, but give the conflicting forces of the profit motive, I have my doubts.

Strength, courage, and peace to all.

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@jodeej How lucky you have consistency with your pharmacies! That is so nice! Big or small, knowing the person behind the counter knows a bit about your history is comforting for sure! I spoke with one of the pharmacists at our chain and she explained the chain moves the pharmacists around their various shops, keeps them under a certain number of hours and thereby keeps them on the books as part-time and not fulltime employees. All part of the games they play these days I guess! Perhaps one day the pendulum will swing back!

Strength, courage, and peace!

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Moderator
Colleen Young, Connect Director | @colleenyoung | Apr 24, 2018
In reply to @jaler "Mayo requires that you update your list of prescriptions they have on file each time you..." + (show)
@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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Hi Judy,
I did some digging and found out a bit more about medication reviews and associated costs. At Mayo, we refer to this as Medication therapy management (MTM).

MTM does carry a cost. MTM is sometimes covered under a patients prescription benefit. Patients can contact their insurance to find out if MTM services would be covered under their plan. Many patients do pay out of pocket for this service. Sometimes medications can be eliminated or changed to less expensive alternatives which reduces overall cost resulting in a net financial benefit even considering the cost of the MTM service. Of course, this is not always the case. You can read more about what services may be covered by Medicare plans at https://www.medicare.gov/part-d/coverage/medication-therapy-management/medication-therapy-programs.html.

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Judy | @jaler | Apr 25, 2018
In reply to @jaler "Mayo requires that you update your list of prescriptions they have on file each time you..." + (show)
@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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Thanks.  I checked the Medicare site and don’t think they pay.   I’m surprised Mayo doesn’t check since I provide them with my medications printed each time I go there.  What do they charge for this service?  And why do they need the medications list at each visit if no one looks at it?JudyLong 

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prudence | @prudence | Apr 25, 2018
In reply to @cindylb "Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors..." + (show)
@cindylb

Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors involved in the care of one patient meds can get confusing. Each doctor is 'tasked' with certain duties for a patient. In the case of cancer, it's curing cancer and sometimes that seems to be at the exclusion of other concerns (sometimes). It's their job and 'ego' to cure or get cancer in remission. At times that can be at the cost of side effects from drugs or other conditions that send you off to another type of doctor. Of course, not all doctors think so singularly.........some do consider the side effects and long term effects of treatments and medications. But I do believe any patient either needs a caretaker or support person in their corner or if they're on their own.....a group like this that gives them multiple perspectives. I liked your "Kramer v. Kramer" analogy. I've hit that point a couple of times myself!

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Try cosco for cheap cheap medication cost and pharmacy review free. You don’t have to be a member either to use drug service. I would like to shout it from the rooftops ‘ try this please

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Judy | @jaler | Apr 25, 2018
In reply to @cindylb "Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors..." + (show)
@cindylb

Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors involved in the care of one patient meds can get confusing. Each doctor is 'tasked' with certain duties for a patient. In the case of cancer, it's curing cancer and sometimes that seems to be at the exclusion of other concerns (sometimes). It's their job and 'ego' to cure or get cancer in remission. At times that can be at the cost of side effects from drugs or other conditions that send you off to another type of doctor. Of course, not all doctors think so singularly.........some do consider the side effects and long term effects of treatments and medications. But I do believe any patient either needs a caretaker or support person in their corner or if they're on their own.....a group like this that gives them multiple perspectives. I liked your "Kramer v. Kramer" analogy. I've hit that point a couple of times myself!

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Thanks for the information.  I have a prescription drug plan and can only use Walgreen&apos;s.  I&apos;m an exec member at Costco.  Will Costco review my drugs if I don&apos;t get my prescriptions there?  I&apos;m very surprised and somewhat appalled that Mayo requires a copy of prescriptions at each visit and then doesn&apos;t review them.

Judy Long

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jodeej | @jodeej | Apr 25, 2018
In reply to @cindylb "Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors..." + (show)
@cindylb

Indiana Scott - you bring up another interesting point regarding medications. When you have multiple doctors involved in the care of one patient meds can get confusing. Each doctor is 'tasked' with certain duties for a patient. In the case of cancer, it's curing cancer and sometimes that seems to be at the exclusion of other concerns (sometimes). It's their job and 'ego' to cure or get cancer in remission. At times that can be at the cost of side effects from drugs or other conditions that send you off to another type of doctor. Of course, not all doctors think so singularly.........some do consider the side effects and long term effects of treatments and medications. But I do believe any patient either needs a caretaker or support person in their corner or if they're on their own.....a group like this that gives them multiple perspectives. I liked your "Kramer v. Kramer" analogy. I've hit that point a couple of times myself!

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@jaler the nurse reviews them with you, or does with us anyway, but they don't know what interacts with what. That's a pharmacist's job.

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jodeej | @jodeej | Apr 25, 2018

@gaybinator what a great idea! Mayo has given us copies to keep when we are there, but I like this better. Thank you!

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Moderator
Colleen Young, Connect Director | @colleenyoung | Apr 25, 2018
In reply to @jaler "Mayo requires that you update your list of prescriptions they have on file each time you..." + (show)
@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

Jump to this post

Judy,
Mayo Clinic providers do screen for drug therapy issues. It is always a good idea to mention changes or concerns with your provider at your appointments in addition to documenting them. Pharmacists are available for consultation on complicated therapies, detailed reviews or questions. You can ask your pharmacy for more information about costs and availability of medication therapy management MTM or contact Mayo Clinic at the location you use https://www.mayoclinic.org/appointments

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