Supportive Care in Cancer

, Volume 21, Issue 5, pp 1287–1293 | Cite as

The impact of medication therapy management in older oncology patients

Original Article



This project aimed to identify common drug-related problems (DRP) among elderly cancer patients, to determine the effectiveness of medication therapy management (MTM) service in resolving DRP, to determine the clinical significance of pharmacist interventions, and to determine patients’ satisfaction level of MTM service.


Elderly cancer patients (age ≥65) who were at least on one chronic medication would be eligible for the MTM service. Any DRP that was detected would be recorded and steps to resolve it were taken. Pre- and post-service patient satisfaction surveys (PSS) were conducted before and after MTM. All interventions performed by MTM pharmacists were subjected to independent evaluation by a panel of three judges.


One hundred eighteen patients received at least one session of MTM. We identified and attempted to resolve 361 DRPs, and the most common DRPs were drug interactions (117 cases, 32.4 %), adverse effects (114 cases, 31.6 %), and non-adherence (48 cases, 13.3 %). Forty-four interventions were performed by pharmacists and forty cases (91 %) were accepted by physicians. Almost two third of these interventions were deemed significant (or higher) by the judges. Seventy-two patients completed PSS. There was statistically significant improvement in patients’ satisfaction level after the service was provided.


MTM is an important platform in identifying and managing DRPs. Patients are generally satisfied with MTM services.


Medication therapy management Drug-related problems Elderly cancer patients 


Conflict of interest

The authors of this manuscript have full control of all primary data and we are agreeable to allowing the journal to review our data if requested.


This study was done with funding from the Healthcare Quality Improvement Funding, Ministry of Health, Singapore.


  1. 1.
    American Pharmacist Association (APhA). (2004) Medication therapy management services definition and program criteria Jul 2004. Available at Assessed 05 October 2011
  2. 2.
    American College of Clinical Pharmacy Position Statement (2004) Medication therapy management services definition and program criteria. Available at Assessed 24 October 2011
  3. 3.
    Oliveira DR, Brummel AR, Miller DB (2007) Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm 16(3):185–195Google Scholar
  4. 4.
    Welch E, Delate T, Chester EA, Stubbings T (2009) Assessment of the impact of medication therapy management delivered to home-based Medicare beneficiaries. Ann Pharmacother 43:603–610PubMedCrossRefGoogle Scholar
  5. 5.
  6. 6.
    Smith BD, Smith GL, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765PubMedCrossRefGoogle Scholar
  7. 7.
    Population Reference Bureau (2010) Today’s research on aging. July. No. 20. Assessed 16 September 2011
  8. 8.
  9. 9.
    Hajjar ER, Cafiero AC, Hanlon JT (2007) Polypharmacy in elderly patients. Am J Geriatr Pharmacother 5(4):345–351PubMedCrossRefGoogle Scholar
  10. 10.
    Terret C (2005) Geriatric oncology—a challenge for the future. Eur Oncol Rev 24–26Google Scholar
  11. 11.
    Wedding U, Pientka L, Hoffken K (2007) Quality of life in elderly patients with cancer: a short review. Eur J Cancer 43:2203PubMedCrossRefGoogle Scholar
  12. 12.
  13. 13.
    Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25(14):1824–1831PubMedCrossRefGoogle Scholar
  14. 14.
    Poon D (2008) Challenges in the practice of geriatric oncology in a national comprehensive cancer centre in Asia. Asia-Pac Oncol Haematol 1:67–68Google Scholar
  15. 15.
    American Society of Hospital Pharmacists (1993) ASHP statement on pharmaceutical care. Am J Hosp Pharm 50:1720–1723Google Scholar
  16. 16.
    Hanlon JT, Lindblad CIL, Hajjar ER, McCarthy TC (2003) Update on drug-related problems in the elderly. Am J Geriatr Pharmacother 1(1):38–43PubMedCrossRefGoogle Scholar
  17. 17.
    Goldberg RM, Tabah-Fisch I, Bleiberg H et al (2006) Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly cancer patients with colorectal cancer. J Clin Oncol 24(25):4085–4091PubMedCrossRefGoogle Scholar
  18. 18.
    Litchman SM, Hollis D, Antonius A et al (2006) Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: cancer and leukemia group B (CALGB 9762). J Clin Oncol 24(12):1846–1851CrossRefGoogle Scholar
  19. 19.
    Wedding U, Honecker F, Bokemeyer C, Pientka L, Hoffken K (2007) Tolerance to chemotherapy in elderly patients with cancer. Cancer Control 14(1):44–56PubMedGoogle Scholar
  20. 20.
    Litchman SM, Buchholtz M, Marino J et al (1992) Use of cisplatin for elderly patients. Age Ageing 21:202–204CrossRefGoogle Scholar
  21. 21.
    Smorenburg CH, ten Tije AJ, Bontenbal M et al (2003) Altered clearance of unbound paclitaxel in elderly patients with metastatic breast cancer. Eur J Cancer 39:196–202PubMedCrossRefGoogle Scholar
  22. 22.
    Albert J, Ten T, Verweij J, Carducci MA et al (2005) Prospective evaluation of the pharmacokinetics and toxicity profile of docetaxel in the elderly. J Clin Oncol 23(6):1070–1077CrossRefGoogle Scholar
  23. 23.
    Hurria A, Togawa K, Mohile SG et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465PubMedCrossRefGoogle Scholar
  24. 24.
    Extermann M, Boler I, Reich R et al (2010) The Chemotherapy Risk Assessment Scale for High-age patients (CRASH) score: design and validation. J Clin Oncol 28:15s, suppl; abstract 9000Google Scholar
  25. 25.
    Rhoads M, Thai A (2003) Physician acceptance rate of pharmacist recommendations to reduce use of potentially inappropriate medications in the assisted living setting. Consult Pharm 18(3):241–247PubMedGoogle Scholar
  26. 26.
    Von Muenster SJ, Carter BL, Weber CA, Ernst ME, Milchak JL, Steffensmeier JJ, Xu Y (2008) Description of pharmacist interventions during physician–pharmacist co-management of hypertension. Pharm World Sci 30(1):128–135CrossRefGoogle Scholar
  27. 27.
    Doucette WR, McDonough RP, Klepser D, McCarthy R (2005) Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy. Clin Ther 27(7):1104–1111PubMedCrossRefGoogle Scholar
  28. 28.
    McCollum M, Nuffer W, Ellis SL, Turner CJ (2009) Physician acceptance of pharmacotherapy recommendations made by pharmacy students in a rural pharmacy-based diabetes care and education clinic. Am J Pharm Educ 73(2):24PubMedCrossRefGoogle Scholar
  29. 29.
    Lundquist LM, Moye PM (2009) Resident physicians’ acceptance of pharmacy students’ pharmacotherapy recommendations during an ambulatory care advanced pharmacy practice experience. Am J Pharm Educ 73(8):145PubMedCrossRefGoogle Scholar
  30. 30.
    Wilson S, Wahler R, Brown J, Doloresco F, Monte SV (2011) Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Med 28(5):316–320CrossRefGoogle Scholar
  31. 31.
    Chumney EC, Robinson LC (2006) The effects of pharmacist interventions on patients with polypharmacy. Pharm Pract 4(3):103–109Google Scholar
  32. 32.
    Shah S, Dowell J, Greene S et al (2006) Evaluation of clinical pharmacy services in a haematology/oncology outpatient setting. Ann Pharmacother 40:1527–1533PubMedCrossRefGoogle Scholar
  33. 33.
    Kjeldsen LJ, Jensen TB, Jensen JJ et al (2011) Physicians’ evaluation of clinical pharmacy revealed increased focus on quality improvement and cost savings. Dan Med Bull 58(5):A4261PubMedGoogle Scholar
  34. 34.
    Alsoud NA, El-Hamamsy M, Zawahry HA, Al-Azizi M (2010) Effects of clinical pharmacist interventions on clinical outcomes in oncology patients. Res J Med Med Sci 5(2):133–141Google Scholar
  35. 35.
    Ganachari MS, Mahendra Kumar BJ, Shashikala CW, Fibin M (2010) Assessment of drug therapy interventions by clinical pharmacist in a tertiary care hospital. Indian J Pharm Pract 3(3):22–28Google Scholar
  36. 36.
    Knez L, Laaksonen R, Duggan C et al (2010) Evaluation of clinical interventions made by pharmacists in chemotherapy preparation. Radiol Oncol 44(4):249–256PubMedCrossRefGoogle Scholar
  37. 37.
    Barnett MJ, Frank J, Wehring H et al (2009) Analysis of pharmacist provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 15(1):18–31PubMedGoogle Scholar
  38. 38.
    McMahan R (2008) Operationalizing MTM through the use of health information technology. J Manag Care Pharm 14(2 Suppl):S18–S21PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Pharmacy DepartmentNational Cancer Centre SingaporeSingaporeSingapore
  2. 2.Pharmacy DepartmentNational University of SingaporeSingaporeSingapore

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