Is my older cancer patient on too many medications?

Abstract

"Is my older cancer patient on too many medications?" is a question that confronts many physicians. Increasing age is associated with an increase in comorbidity, and consequently an increase in the number of medications prescribed to provide symptomatic relief and prevent disease related sequelae. The use of multiple medications, often termed polypharmacy, is highly prevalent in older people with cancer. Polypharmacy is not necessarily inappropriate but has been associated with drug-drug interactions, use of potentially inappropriate medications and a range of adverse events. Specific medications for which the risks outweigh the benefits are considered inappropriate, particularly when safer alternatives exist. Additionally, the appropriateness of medication therapy for both cancer and non-cancer indications is dependent on a patient's life expectancy and treatment goals. A range of implicit and explicit tools are available to assist clinicians work as part of a multidisciplinary team to identify inappropriate or unnecessary medications. Inappropriate or unnecessary medications can be targeted for cessation. Deprescribing is the patient-centered process of reducing medications after consideration of treatment goals, benefits and risks, and medical ethics. A six step process for deprescribing in older patients with cancer is presented; 1) determine life expectancy and treatment goals, 2) review medications, 3) evaluate medication appropriateness, 4) identify medications to cease, 5) create a deprescribing plan, and 6) monitor and review. Although further research is required, there is an increasing body of research demonstrating that deprescribing inappropriate or unnecessary medications is feasible, can be done safely, and can improve patient quality of life.

Keywords: Aged; Aged 80 and over; Cancer; Deprescribe; Frail elderly; Geriatric oncology; Inappropriate prescribing; Medical oncology; Polypharmacy.