Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC)

Cadogan, Cathal; Murphy, Melanie A.; McLean, Sarah; Bennett, Kathleen; Hughes, Carmel

doi:10.1016/j.jgo.2021.06.003

Cited by 4 publications

(7 citation statements)

References 61 publications

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“…If the upper quartile was ≤2, the alternative was rejected, and, if the lower quartile was ≥4, the alternative was accepted. These are equivalent to ≥75% disagreeing or agreeing with the adequate alternative respectively, in line with previous research 11,23,24 . If the interquartile range included 3, then no clear consensus had been reached.…”

Section: Methodssupporting

confidence: 67%

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Cost outcomes of potentially inappropriate prescribing in middle‐aged adults: A Delphi consensus and cross‐sectional study

Jayesinghe

Moriarty²,

Khatter

et al. 2022

Brit J Clinical Pharma

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Background: Potentially inappropriate prescribing (PIP) is common in older adults and is associated with increased medication costs and costs of associated adverse drug events. PIP also affects almost 1/5 of middle-aged adults (45-64 y), as defined by the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria.However, there has been little research on PIP medication costs within this age group.Aims: Calculate the medication costs of PIP for middle-aged adults according to the 22 PROMPT criteria and compare with the cost of consensus-validated, evidencebased (adequate) alternative prescribing scenarios. Methods: Adequate alternatives to the 22 PROMPT criteria were created via literature review. A Delphi consensus panel of experts was recruited (n = 16), supported by a patient and public involvement group, to achieve consensus on the alternatives. A retrospective repeated cross-sectional study from 2014 to 2019 was then conducted utilising pseudonymised primary care data from Lambeth DataNet in South London (41 general practices, n = 1 185 335, using Lambeth DataNet May 2020 extract) to calculate the cost of PIP. Results: The cross-sectional study included 55 880 patients. The total PIP cost was £2.79 million, with adequate alternative prescribing costing £2.74 million (cost savings of £51 278). Duplicate drug classes was the most costly criterion for both PIP and alternative prescribing. Conclusion: This study calculated the medication costs of PIP and created alternative prescribing scenarios for the 22 PROMPT criteria. There is no substantial cost difference between adequate prescribing vs. PIP. Future studies should investigate the wider health economic costs of alternative prescribing, such as reducing hospital admissions.

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Section: Methodssupporting

confidence: 67%

“…These are equivalent to ≥75% disagreeing or agreeing with the adequate alternative respectively, in line with previous research. 11,23,24 If the interquartile range included 3, then no clear consensus had been reached.…”

Section: What This Study Addsmentioning

confidence: 99%

Cost outcomes of potentially inappropriate prescribing in middle‐aged adults: A Delphi consensus and cross‐sectional study

Jayesinghe

Moriarty²,

Khatter

et al. 2022

Brit J Clinical Pharma

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“…Several validated tools such as the Beers criteria [131] and the STOPP/START criteria [132] can be used by both pharmacists and clinicians to identify patients at risk of polypharmacy. Tools created for use in older patients with cancer also exist and include the OncPal deprescribing guideline [133] and the PIP-CPC criteria [134] although both were developed for use in patients receiving palliative care. and the latter is a newer tool that has not yet been validated.…”

Section: Prevention and Management Of Functional Declinementioning

confidence: 99%

Functional Decline in the Cancer Patient: A Review

Muhandiramge

Orchard

Warner

et al. 2022

Cancers

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A decline in functional status, an individual’s ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.

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“…Describe the medications received during the last week of life in a cohort of older adults with cancer; 2. Identify the prevalence of PIP using three tools: STOPP-Frail (Version 1 and 2) [18,20], OncPal [19] and PIP-CPC [21]; 3. Determine the association between the presence of PIP and each of the following variables: gender, age, number of other health conditions and number of medications in the cohort of older patients with cancer.…”

Section: Aimmentioning

confidence: 99%

“…To ensure appropriate prescribing, it is also important to consider potential prescribing omissions (PPOs) of medications for symptom control at end of life. The PIP-CPC criteria (criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care) were recently developed to identify PIP involving medications for symptomatic relief in older adults with cancer and limited life expectancy [21]. However, to date, the application of these tools to older adults with cancer has been lacking [16].…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study

Murphy¹,

Bennett²,

Wright³

et al. 2022

Int J Clin Pharm

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Background Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications. Aim To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting. Method Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC). Results 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)). Conclusion This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.

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Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC)

Cited by 4 publications

References 61 publications

Cost outcomes of potentially inappropriate prescribing in middle‐aged adults: A Delphi consensus and cross‐sectional study

Cost outcomes of potentially inappropriate prescribing in middle‐aged adults: A Delphi consensus and cross‐sectional study

Functional Decline in the Cancer Patient: A Review

Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study

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