Reducing potentially inappropriate medication use and patient harm in a dedicated geriatric oncology clinic: a cross-sectional study

Abstract

Abstract Introduction International guidance on conducting medication reviews in older adults with cancer was published in June 2022,[1] and current clinical practices have been outlined by pharmacists working in this field.[2] This process includes assessing for drug-drug interactions (DDIs), potentially inappropriate medications (PIMs), and assessing anticholinergic burden (ACB), all of which have been associated with poorer outcomes in older adults with cancer.[2] Since July 2022, the Geriatric Oncology Assessment and Liaison (GOAL) Clinic in our tertiary cancer centre has offered a comprehensive geriatric assessment (CGA) to patients ≥70 years, which includes a comprehensive geriatric pharmacological assessment (CGPA), performed by the primary author. Aim Identify pharmacist interventions that resulted in a reduction of medication use in older adults attending a geriatric oncology clinic. Methods Data were collected between July 2022 and September 2023 inclusive. Patients who attended the GOAL clinic consented and underwent a CGPA. The CGPA database was analysed to assess for recommendations that reduced medication usage via two metrics: (i) reduced doses of medications; (ii) deprescribing of medications. Descriptive statistics were used to analyse the data (Table 1). Results One hundred and seventy four patients (98%) consented to a CGPA. Interventions to reduce medication use occurred in 120 patients (69%). There were 199 total number of interventions, with some patients having more than one intervention. The nature of the interventions are described in Table 1. Conclusion A structured medication review in the form of a CGPA, alongside a multidisciplinary CGA is effective at identifying potential areas to reduce medication usage in older adults with cancer, through appropriate dose reductions and deprescribing strategies. This service is unique as the GOAL clinic is Ireland’s only dedicated geriatric oncology clinic. The utilisation of a clinical pharmacist in a geriatric oncology outpatient clinic can effectively identify opportunities to reduce inappropriate medication, with almost 70% of patients being identified as being prescribed potentially inappropriate medications. This study was limited to the outpatient setting only. Future research should consider the impact of pharmacist review of medications for older adults with cancer at transitions of care.