Jefferson: Currently used tools to prevent over-medicating senior cancer patients need improvement. Open the medicine cabinet of a senior and you’re likely to find scores of pill bottles. Physicians are often unaware of all the medications a patient is taking, which can result in unnecessary additional prescriptions, non-prescription medications and potential drug-drug interactions that cause unexpected adverse effects. When a cancer diagnosis is thrown into the mix, the drug-drug interactions can become even more complex. A new study evaluates the currently available screening tools for determining if and when seniors with cancer are taking too many medications and finds that a more comprehensive medication assessment and monitoring plan is needed to improve treatment for this population.
“To our knowledge, this study is the first to combine a clinical
pharmacist’s expert assessment together with clinically validated,
up-to-date criteria and screening tools used by researchers in the
field,” says first author Ginah Nightingale, PharmD, BCOP, Assistant
Professor in the Department of Pharmacy Practice in the Jefferson School of Pharmacy
at Thomas Jefferson University. “There is still a lot we don’t know
about the impact of excessive and potentially inappropriate medication
use for senior adults with cancer, specifically in terms of whether and
how increased pill burdens might lead to compromised cancer management
plans.” For example, inappropriate medications could cause treatment
delays and/or premature discontinuation of treatment.
The study was published in the Journal of Clinical Oncology Monday March 23rd.
Cancer is a disease that is much more common in the elderly, with 60
percent of cancers occurring in patients over the age of 65. As the
numbers of elderly individuals grows in the United States, physicians
who manage their care will have an increasing list of medications to
As part of a multidisciplinary clinic in which senior oncology
patients are seen by an interprofessional healthcare team including a
medical oncologist, geriatrician, clinical pharmacist, social worker and
dietician, the Jefferson researchers looked at drug regimens of 234
seniors. They used three standard evaluation tools surveys called the
Beers criteria list, the STOPP survey, and the HEDIS criteria that were
designed to identify medications with a higher risk of causing adverse
events in older adults.
Of the 234 senior oncology patients evaluated, 43 percent were taking
more than 10 medications at once, and 51 percent of the total were
taking potentially inappropriate mediations.
“This is a vulnerable population,” says Andrew Chapman, D.O., senior
author on the paper and Co-Director of the Multidisciplinary Senior
Adult Oncology Center clinic at Jefferson. “They are prescribed
complicated medical regimens that have a real risk of interfering with
their cancer care.”
“It’s difficult for an able-bodied adult to keep track of the dosing
schedules and appropriate administration of 10 medications, much less
for a senior who may have underlying functional or cognitive
impairment,” says Dr. Nightingale. “This study is meant to give us a
baseline, a sense of the landscape, and the risks involved in this
population of cancer patients.”
Now that the baseline is established, says Nightingale, the next
steps are to develop a tool that combines the currently available
assessments and considers cancer diagnosis, prognosis, and
cancer-related therapy in order to minimize the use of inappropriate
medication in the elderly. In addition, comprehensive medication
assessments and monitoring plans should be implemented and completed
routinely for all patients.
One of the authors, Emily Hajjar, received honoraria, and travel
expenses from Prime Therapeutics and Kaplan. Another author, Jocelyn
Andrel Sendecki, is employed by Janssen Pharmaceuticals. The authors
report no other conflicts of interest.
For more information, contact Edyta Zielinska, 215-955-5291, firstname.lastname@example.org.
About Jefferson — Health is all we do.
Thomas Jefferson University, Thomas Jefferson University Hospitals
and Jefferson University Physicians are partners in providing the
highest-quality, compassionate clinical care for patients, educating the
health professionals of tomorrow, and discovering new treatments and
therapies that will define the future of healthcare. Thomas Jefferson
University enrolls more than 3,600 future physicians, scientists and
healthcare professionals in the Sidney Kimmel Medical College (SKMC);
Jefferson Schools of Health Professions, Nursing, Pharmacy, Population
Health; and the Graduate School of Biomedical Sciences, and is home of
the National Cancer Institute (NCI)-designated Sidney Kimmel Cancer
Center. Jefferson University Physicians is a multi-specialty physician
practice consisting of over 650 SKMC full-time faculty. Thomas Jefferson
University Hospitals is the largest freestanding academic medical
center in Philadelphia. Services are provided at five locations — Thomas
Jefferson University Hospital and Jefferson Hospital for Neuroscience
in Center City Philadelphia; Methodist Hospital in South Philadelphia;
Jefferson at the Navy Yard; and Jefferson at Voorhees in South Jersey.
Article reference: G. Nightingale et al., “Evaluation of a
Pharmacist-Led Medication Assessment Used to Identify Prevalence of and
Associations With Polypharmacy and Potentially Inappropriate Medication
Use Among Ambulatory Senior Adults With Cancer,” J Clin Oncol, 2015.