How to get smarter on pills for seniors

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. The study was published in the Journal of Clinical Oncology (2015; doi:10.1200/JCO.2014.58.7550).

The medicine cabinets of many seniors are likely to have scores of pill bottles in them. Physicians are often unaware of all the medications a patient is taking, which can result in unnecessary additional prescriptions, nonprescription 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.

"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," said first author Ginah Nightingale, PharmD, BCOP, assistant professor in the Department of Pharmacy Practice in the Jefferson School of Pharmacy at Thomas Jefferson University in Philadelphia, Pennsylvania.

"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.

Cancer is a disease that is much more common in the elderly, with 60% of cancers occurring in patients older than 65 years. As the numbers of elderly persons grows in the United States, physicians who manage their care will have an increasing list of medications to contend with.

As part of a multidisciplinary clinic in which senior oncology patients are seen by an interprofessional health care 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: the Beers criteria list, the STOPP survey, and the HEDIS criteria. These surveys were designed to identify medications with a higher risk of causing adverse events in older adults.

Of the 234 senior oncology patients evaluated, 43% were taking more than 10 medications at once, and 51% of the total were taking potentially inappropriate mediations.

"This is a vulnerable population," said Andrew Chapman, DO, 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," said 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."

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