<p>Medication Reconciliation Associated with Comprehensive Geriatric Assessment in Older Patients with Cancer: ChimioAge Study</p>

Abstract

Background Polymorbidity induces polypharmacy in older patients may lead to potential drug–drug interactions (DDI) which can modify the tolerance and safety of oncological treatments and alter the intended therapeutic effect. The objective of our study was to describe the decision-making process for oncological treatment and related outcomes, in a population of older adults undergoing a comprehensive geriatric assessment (CGA) associated to a comprehensive medication reconciliation (CMR) prior to initiating oncological treatment. Methods ChimioAge is a prospective observational study conducted between 01/2017 and 07/2018 at Marseille University Hospital and approved by the French National Ethics Committee. It comprised all consecutive patients aged 70 years and over who were referred for a CGA as part of CMR, before initiating systemic treatment. Results One hundred and seventy-one cancer patients were included. Mean age was 79.2 years, over half had metastatic cancers, 75% had an ECOG performance status zero or one, and two-thirds were independent in daily activities. Two-thirds of the patients had polypharmacy and the CMR identified potential DDI with systemic treatment in 43.3% of patients. Following the CGA, the CMR and the hospital oncologists decision, 30% of the patients received adapted systemic treatment with reduced doses at initiation. They presented fewer toxicities – irrespective of grade and type – than patients who received standard treatment (p<0.001) and had comparable overall survival (Log rank p=0.21). Conclusion This is one of the first studies to highlight the value in conducting CMR and a CGA simultaneously before initiating systemic treatment in older patients with cancer. These two evaluations could give oncologists decisive information to personalize cancer treatment of older patients and optimize treatment dose to offer the best efficacy and minimize toxicity.

Acceptance, efficacy, and safety of COVID-19 vaccination in older patients with cancer

“…This research is a study focused on vaccination prescription before oncological treatment, derived from the ongoing prospective observational cohort study “ChimioAge”, initiated in January 2017 at Marseille University Hospital ( NCT03960593 ) [ 17 ]. The ChimioAge cohort aims to collect geriatric, oncological and drug prescriptions data of all consecutive patients aged 70 years or over with cancer, referred to our geriatric oncology center for geriatric advice before initiation of treatment.…”

“…The CGA, including assessment of autonomy, cognitive status, nutritional status, mobility, handgrip strength and polypharmacy (minimum of five prescribed medications) was assessed by both validated psychometric scales and clinical assessment, and has been previously detailed [ 17 ]. Information about demographic characteristics and lifestyle (age, gender, accommodations and presence of a caregiver) were also collected.…”