Comparison of validated screening tools for the assessment of potentially inappropriate medications in older Indian patients with cancer.

Abstract

e24018 Background: The use of potentially inappropriate medication (PIM) and polypharmacy are highly prevalent in older cancer patients and are recognized as potential risk factors for adverse outcomes during cancer treatment. With geriatric cases increasing steadily in India, there is a need for comprehensive studies to identify a reliable screening tool for the assessment of PIMs. Methods: Retrospective analysis of patients ≥ 60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India between 2018-2021. Five tools (Beers-2015, STOPP and START-2014, PRISCUS-2010, FORTA-2018, and the EU (7)-PIM list-2015) were used to assess PIM. A standardized PIM value (SPV) was assigned for each patient for each scale which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all 5 scales for each patient was considered the reference standard. Agreement between each scale and the reference was carried out using Bland-Altman plots. The agreement was determined based on bias and the width of the limit of agreement. Association between categorical variables such as sex, comorbidities, and number of medications (above and below the median) and PIM use was determined using the chi-squared test. Results: 352 patients were included; median age - 70(range: 60-100) years, 287 (81.6%) were males. The bias and limit of agreement given by the Bland-Altman plot for each scale is shown in Table 1. The EU(7)-PIM list was found to have the least bias of 0.7% and the narrowest limits of agreement of 0.43 (-0.21 to 0.22). PIM use was observed to be significantly higher in patients with diabetes than without (83/281 versus 13/82, respectively, p = 0.013) and, patients prescribed with > 7 medications compared with ≤7 (137/281 versus 06/70, respectively, p < 0.001). Conclusions: The EU(7)-PIM list was found to have the least bias and thus considered the most reliable among all other scales in our study population. A high degree of discordance was observed between the tools, thus, we emphasize the need for future studies to identify the most reliable tool for the prediction of PIMs to aid clinical decision-making in geriatric practice.[Table: see text]