Polypharmacy cut-points in older people with cancer: how many medications are too many?

Turner, Justin P.; Jamsen, Kris; Shakib, Sepehr; Singhal, Nimit; Prowse, Robert; Bell, John

doi:10.1007/s00520-015-2970-8

Cited by 119 publications

(81 citation statements)

References 43 publications

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“…They also found that taking greater than 6.5 medications correlated with reduced performance status and frailty. This study did not evaluate PIMs or specific medication classes [17]. Studies involving a clinical intervention for PP/PIMs are sparse.…”

Section: Discussionmentioning

confidence: 99%

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

Whitman

DeGregory

Morris

et al. 2018

Support Care Cancer

102

149

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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 $4,282.27 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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Section: Discussionmentioning

confidence: 99%

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

Whitman

DeGregory

Morris

et al. 2018

Support Care Cancer

102

149

View full text Add to dashboard Cite

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“…12 Taking 5 or more regular medications has been associated with falls, disability, and frailty in general geriatric populations and in geriatric oncology, and thus has some justification as a reasonable cut-point for polypharmacy based on the association with adverse outcomes in older patients. 13, 14 For example, the sensitivity and specificity for 5 or more medications and the risk of falls is 75.7% and 44.5%, respectively; at a cut-point of 10 or more medications, the sensitivity is 24.3% and specificity is 85.5%. 14 …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and potentially inappropriate medication use in geriatric oncology

Sharma

Loh

Nightingale

et al. 2016

Journal of Geriatric Oncology

178

107

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Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods.

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“…Around 20% of patients take 10 or more drugs and 10%-30% experience an adverse drug event in the course of a year. In around 4%, there is a life-threatening drug-drug interaction 26 . Altered physiology and drug handling, cormorbidities and co-medications (which frequently include non-prescription and herbal agents) interact to affect pharmacokinetics and pharmacodynamics.…”

Section: De-escalation Options For Elderly Patientsmentioning

confidence: 99%

Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

Stepney¹

2016

Cancer Biology &Amp; Medicine

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A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.

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Polypharmacy cut-points in older people with cancer: how many medications are too many?

Abstract: Our results suggest that no single polypharmacy cut-point is optimal for predicting multiple adverse events in older people with cancer. In this population, the common definition of five-or-more-medications is reasonable for identifying 'at-risk' patients for medication review.

Cited by 119 publications

References 43 publications

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

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

Polypharmacy and potentially inappropriate medication use in geriatric oncology

Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

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