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Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study

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Abstract

Purpose

The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic.

Methods

Adult patients with cancer aged 65 and older underwent a comprehensive geriatric assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies. Potentially inappropriate medications were screened using the Beers Criteria, Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons’ Prescriptions, and the Medication Appropriateness Index. Deprescribing occurred after discussion with the pharmacist, geriatric oncologist, patient, and caregiver.

Results

Data were collected for 26 patients. The mean number of medications was 12. The Beers Criteria alone identified 38 potentially inappropriate medications compared to 119 potentially inappropriate medications with the three-tool assessment; a mean of 5 potentially inappropriate medications were identified per patient. After the application of the three-tool assessment, 73% of potentially inappropriate medications identified were deprescribed, resulting in a mean of 3 medications deprescribed per patient. Approximately two thirds of patients reported a reduction in symptoms after the deprescribing intervention. Healthcare expenditures of $4282.27 per patient were potentially avoided as a result of deprescribing.

Conclusions

Our three-tool assessment identified three times more potentially inappropriate medications than the Beers Criteria alone. Pharmacist-led deprescribing interventions are feasible and may lead to improved patient outcomes and cost savings. This three-tool assessment process should be incorporated into interdisciplinary assessments of older patients with cancer and validated in future studies.

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Authors and Affiliations

  1. Department of Pharmacy, University of Virginia Health System, Charlottesville, VA, USA

    Andrew Whitman, Kathlene DeGregory & Amy Morris

  2. Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA

    Supriya Mohile & Erika Ramsdale

Authors
  1. Andrew Whitman
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  2. Kathlene DeGregory
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  3. Amy Morris
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  4. Supriya Mohile
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  5. Erika Ramsdale
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Corresponding author

Correspondence to Andrew Whitman.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Relevance statement

Polypharmacy is a significant issue for older patients, including those with cancer. Due to the complexity of this issue and the potential negative impacts of polypharmacy in older adults, polypharmacy should be seen as a disease. Deprescribing has been touted as one way to reduce polypharmacy and improve patient outcomes. Older adults with cancer may benefit significantly from a reduction in polypharmacy, and pharmacists may be the ideal healthcare professional to evaluate this issue. With rising healthcare costs, an aging population, and an increasing number of patients with multiple comorbidities, the optimization of medications is essential to the health of our patients.

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Whitman, A., DeGregory, K., Morris, A. et al. Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study. Support Care Cancer 26, 4105–4113 (2018). https://doi.org/10.1007/s00520-018-4281-3

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  • DOI: https://doi.org/10.1007/s00520-018-4281-3

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