Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer

Choukroun, Chloé; Leguelinel-Blache, Géraldine; Roux-Marson, Clarisse; Jamet, Charlotte; Martin-Allier, Amy; Kinowski, Jean-Marie; Guillou, Cédric Le; Richard, H.; Antoine, Valéry

doi:10.1016/j.jgo.2020.07.010

Cited by 29 publications

(40 citation statements)

References 33 publications

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“…Studies have shown that pharmacist-led interventions can decrease PIM use (Messerli et al, 2016; Mogensen et al, 2012; Nielsen et al, 2017; Patterson et al, 2014; Tommelein et al, 2017). although some of these studies have been in very specific populations such as patients with cancer (Choukroun et al, 2020). However, education targeted at physicians to decrease PIM prescribing in the first place as well as to encourage regular review may have more impact.…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication Use in the Elderly

et al. 2021

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It is estimated that approximately half of adults, older than 65 years of age, have been prescribed potentially inappropriate medications (PIMs). This study’s objective was to determine the prevalence of PIM use among older patients. Two retrospective chart reviews were performed on 200 and 164 older patients who underwent comprehensive geriatric assessments (CGAs) at outpatient geriatrics clinics at the Glenrose Rehabilitation Hospital (Glenrose) in 2012–13 and at the Misericordia Community Hospital (Misericordia) in 2016–17, respectively. Outcome measures included demographics; prevalence of PIM use; common PIMs used; whether PIM use was addressed, and if so, how; and total number of oral medications. At the Glenrose, the prevalence of PIM use was 45 per cent (90/200). Of the 90 patients who had used PIMs, 46.7 per cent (42/90) had at least one of their medications stopped or modified. At the Misericordia, the prevalence of PIM use was 57.3 per cent (94/164). Of the 94 patients who used PIMs, 47.9 per cent (45/94) had at least one of their medications stopped or modified. These results suggest that an increased awareness of PIM among physicians is needed to further decrease PIM use.

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Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication Use in the Elderly

et al. 2021

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“…Among the identified studies, there were 15 RCTs [58,59,[61][62][63][64][65][66][67][68][69][70][71][72][73], 6 observational cohort studies [74][75][76][77][78][79], 3 before-and-after studies [80][81][82], 2 pilot studies [60,83], 1 descriptive comparison study [84], 1 prospective observational study [85] and 1 secondary analysis study (of RCT) [86].…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

“…The cancer site considered is colorectal cancer (CRC) in 10 studies [59,60,64,67,75,[77][78][79][80][81]; CRC or esophagogastric cancer in 1 study [82]; gastrointestinal cancer (GI) in 1 study [72]; GI, gastro-urinary (GU) or breast cancer in another study [73]; GI or lung cancer in another study [70]; GI or other sites in another study [74]; GU, bladder, kidney or NSCLC in another study [69]; head and neck, lung, upper GI or CRC in another study [71]; NSCLC in another study [66]; prostate, lung, haematologic, GI, head/neck, bladder, renal and other sites in another study [86]; lymphoma, leukaemia or multiple myeloma in another study [65]; solid cancers in 4 studies [61,63,83,85]; solid cancers or lymphoma in another 4 studies [58,62,68,84] and different malignant neoplasms in another study [76].…”

Section: Neutralmentioning

confidence: 99%

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

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“…A recent study by Choukroun et al highlights the importance of collaboration among different providers for reducing polypharmacy and inappropriate medication use. 36 The prospective study evaluated the impact of having a pharmacist and a geriatrician each perform a separate medication review as part of a geriatric assessment in older adults (median age: 83 years) with solid tumor malignancies and an average of four comorbidities. The notable difference between the pharmacist and geriatrician was that the pharmacist used two validated screening tools as part of the assessment.…”

Section: Academic Medical Center Ambulatory Care Settingmentioning

confidence: 99%

Managing Polypharmacy in Older Adults with Cancer Across Different Healthcare Settings

Whitman¹,

Erdeljac²,

Jones³

et al. 2021

DHPS

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The care of older patients with cancer is becoming increasingly complex. Common challenges for this population include management of comorbidities, safe transitions of care, and appropriate medication use. In particular, polypharmacy—generally defined as the regular use of five or more medications—and inappropriate medication use can lead to adverse effects and poor outcomes in older adults with cancer, including falls, hospital readmissions, cognitive impairment, poor adherence to essential medications, chemotherapy toxicity, and increased mortality. Managing polypharmacy across different cancer care settings is often challenging. Providers face barriers to safe and successful medication management that may include lack of time, absence of reimbursement, underappreciation of the scale of polypharmacy-related harm, lack of ownership of deprescribing efforts, and poor communication across care settings. Existing literature on managing inappropriate medication use and polypharmacy in older adults with cancer has often focused on ideal state settings in which resources are plentiful and time is purposefully allocated for medication interventions. This paper presents a narrative, rather than a systematic review, of studies published in the past decade that provided detailed information on medication management and polypharmacy across cancer care settings. This review aims to also summarize different healthcare provider roles in taking action against inappropriate medication use and polypharmacy in older adults with cancer.

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Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer

Cited by 29 publications

References 33 publications

Potentially Inappropriate Medication Use in the Elderly

Potentially Inappropriate Medication Use in the Elderly

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Managing Polypharmacy in Older Adults with Cancer Across Different Healthcare Settings

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