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Randomized Controlled Trial
. 2018 Sep;9(5):534-539.
doi: 10.1016/j.jgo.2018.02.007. Epub 2018 Mar 9.

Geriatric assessment-driven polypharmacy discussions between oncologists, older patients, and their caregivers

Erika Ramsdale  1 , Tatyana Lemelman  2 , Kah Poh Loh  2 , Marie Flannery  2 , Lee Kehoe  2 , Teraisa Mullaney  2 , Megan Wells  2 , Nikesha Gilmore  2 , Sandy Plumb  2 , Supriya Mohile  2
Affiliations
Randomized Controlled Trial

Geriatric assessment-driven polypharmacy discussions between oncologists, older patients, and their caregivers

Erika Ramsdale et al. J Geriatr Oncol. 2018 Sep.

Abstract

Objectives: Polypharmacy (PP) and potentially inappropriate medications (PIM) are common in older adults with cancer, increasing the risk of adverse outcomes. Approaches to identifying and addressing PP/PIM are needed.

Materials and methods: Patients ≥70 years with advanced cancer were enrolled in this cluster-randomized study. All underwent geriatric assessment (GA), and oncologists randomized to the intervention arm received GA-driven recommendations; no information was provided to oncologists at usual care sites. For patients with PP (≥5 medications or ≥1 high-risk medication), clinic visits with treating oncologists were audiorecorded and transcribed, and discussions regarding PP/PIM identified. Quality of provider response was coded as dismissed, mentioned, acknowledged, or addressed.

Results: Forty patient transcripts were analyzed (20 per arm). More discussions occurred in the intervention group (n = 81) versus the usual care group (n = 51). More concerns per patient were brought up in the intervention group (4.1 vs. 2.6, p = 0.07). Physician-initiated discussions were higher in the intervention group (73% vs. 49%, p = 0.006). More PP concerns were "addressed" in the intervention group (59% vs. 45%, p = 0.1). Oncology supportive care medication concerns were more often addressed in the usual care group (58% vs. 18%, p = 0.008), but medication management concerns were addressed more commonly in the intervention group (38% vs. 79%, p = 0.003).

Conclusion: In this secondary analysis, a GA-driven intervention increased PP discussions, particularly about total number of medications and medication management. PP/PIM concerns were more commonly addressed in the intervention group, except for the subset of conversations about supportive care medications.

Keywords: Geriatric assessment; Polypharmacy.

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Conflict of interest statement

Disclosures and Conflict of Interest Statements

The authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
Polypharmacy Concerns Discussed by Group.
Figure 2
Figure 2
Initiation of Polypharmacy Concerns.
Figure 3
Figure 3
Quality of Responses to Polypharmacy Concerns.
See this image and copyright information in PMC

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