Pharmacist medication reviews reduce prescribing problems in older cancer patients

A randomized controlled trial found that a pharmacist-led comprehensive medication review reduced several medication problems among older adults with cancer who regularly used at least five medicines. The study, reported in the Journal of Internal Medicine, included 443 patients aged 65 or older who were receiving oncological rehabilitation. Rather than changing prescriptions directly, the intervention produced an advisory letter containing the pharmacist’s findings for the treating physicians. At the end of the trial, the medication-review group had fewer potentially inappropriate prescriptions, less medication overuse and less medication underuse than the usual-care group.

Patients in the medication-review group were compared with patients receiving usual care. Potentially inappropriate prescriptions were present in 29.9% of the intervention group at the end of the trial, compared with 70.8% of the usual-care group. Medication overuse occurred in 34.2% of participants receiving the review, compared with 64.1% under usual care. The corresponding figures for medication underuse were 44.9% and 73.2%. These measured differences concerned the medication problems assessed in the trial. The supplied research report did not provide results for adverse drug events, hospitalizations, quality of life, cancer progression or survival, so the findings cannot establish whether the intervention prevented clinical harm or improved longer-term cancer outcomes.

The intervention also addressed recommended vaccinations in addition to problems with medicines. Across the medication-review group, pharmacists recommended 337 vaccinations that were reported as missing. The vaccines were against influenza, pneumonia, COVID-19 and/or shingles. The reported result is specifically the number of vaccination recommendations, not a count of vaccinations subsequently administered. The advisory-letter strategy therefore combined medication assessment with identification of recommended immunizations, but the trial evidence summarized here does not describe uptake or completion rates for those vaccines.

Corresponding author Ben Schöttker, PhD, of the German Cancer Research Center, said the pharmacist-led comprehensive medication review used to counsel physicians in oncological rehabilitation wards was highly feasible and substantially improved medication quality among older cancer patients with polypharmacy. The scope of the reported evidence is one randomized trial with 443 participants aged 65 or older, each of whom regularly used at least five drugs. The results apply to the rehabilitation population and the particular review-and-advisory-letter approach evaluated in the study. They show that the intervention was feasible and that participants in the medication-review arm had fewer of the medication problems reported by the investigators than those under usual care.

The central result is a large separation between the groups on all three measured medication-quality indicators at the end of the trial. Potentially inappropriate prescribing was lower by 40.9 percentage points in the medication-review group, while medication overuse was lower by 29.9 percentage points and medication underuse by 28.3 percentage points. These are the observed differences between randomized groups, rather than forecasts or associations from an observational comparison. The research does not show that every older cancer patient would respond in the same way, nor does it establish the effect of the intervention outside oncological rehabilitation. Within those boundaries, the trial provides evidence that a pharmacist-led review communicated to physicians can identify medication problems and recommended vaccinations and can be associated with improved prescribing measures compared with usual care.

Subject of Research: Pharmacist-led medication review for older adults with cancer in rehabilitation

Article Title: Can a pharmacist-led medication review improve medication use in older adults with cancer?

Article References: Can a pharmacist-led medication review improve medication use in older adults with cancer?. Original publication (Bibliographic details unavailable.)

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Keywords: pharmacist-led medication review, older adults, cancer rehabilitation, polypharmacy, inappropriate prescribing, medication overuse, medication underuse, randomized controlled trial, vaccination recommendations, clinical pharmacy, pharmacist-led, medication