Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: A systematic review

Herledan, Chloé; Cerfon, Marie-Anne; Baudouin, Anne; Larbre, Virginie; Lattard, Claire; Poletto, Nicolas; Ranchon, Florence; Rioufol, Catherine

doi:10.1016/j.jgo.2023.101450

Cited by 16 publications

(12 citation statements)

References 36 publications

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“…The study included patients with various types of cancer and reason for admission, in both oncology and geriatrics wards, with a good representation of the population of older patient with cancer treated in the hospital. Polypharmacy rate at admission was consistent with the literature (61%–98% of patients) in geriatric oncology 7,20,24,33 . However, use of CAMs was rather less frequent in our study than previously reported in this population (13%–26.5% of patients) 23,34,35 …”

Section: Discussionsupporting

confidence: 91%

“…The RECAP interventions resulted in the resolution of most DRPs, with a proportion of patients with DRPs reduced by more than a half. These encouraging results highlight the value of our model, as previous studies reported resolution of 20%–40% of DRPs and 20%–25% decrease in proportion of patients with DRPs 24 . However, as in other studies, RECAP had no effect on polypharmacy; indeed, the median number of drugs actually increased at discharge, possibly because of initiation of cancer treatments and supportive medications during hospital stay.…”

Section: Discussionsupporting

confidence: 75%

“…Polypharmacy rate at admission was consistent with the literature (61%-98% of patients) in geriatric oncology. 7,20,24,33 However, use of CAMs was rather less frequent in our study than previously reported in this population (13%-26.5% of patients). 23,34,35 The prevalence and mean number of identified DRPs were consistent, although in the low range, with previous studies in older adults with cancer, reporting DRPs in 78% to 95% of patients with 1.7 to 3 DRPs per patient.…”

Section: Discussioncontrasting

confidence: 75%

“…[15][16][17][18][19] In previous evaluations of pharmaceutical care interventions in older patient with cancer, pharmacists identified DRPs in up to 95% of patients and enabled the resolution of up to 40% of DRPs. [20][21][22][23][24] Few studies were conducted in inpatients settings, although hospitalized patients may be fragile, with acute conditions or cancer progression. [25][26][27] Deliens et al reported the only comprehensive intervention at both admission and discharge in a geriatric oncology unit, in 91 patients ≥70 years.…”

Section: Introductionmentioning

confidence: 99%

“…In previous evaluations of pharmaceutical care interventions in older patient with cancer, pharmacists identified DRPs in up to 95% of patients and enabled the resolution of up to 40% of DRPs 20–24 . Few studies were conducted in inpatients settings, although hospitalized patients may be fragile, with acute conditions or cancer progression 25–27 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical impact and cost‐saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer

Herledan,

Falandry,

Huot

et al. 2023

J American Geriatrics Society

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BackgroundHospital admission and discharge are at high risk of drug‐related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards.MethodRECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time.ResultsFrom January 2019 and August 2020, 201 patients were included (median age 80 [75–97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient).ConclusionsThe RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 75%