OncoSTRIP for optimizing pharmacotherapy in elderly oncology patients with polypharmacy

Background

Polypharmacy in geriatric oncology is associated with more treatment related toxicity and a higher frequency of drug-drug interactions with oncology drugs. Polypharmacy assessment has been introduced as part of care of several high risk patient groups, however experience in oncology patients is limited and no standardized method is available. We aimed to develop a polypharmacy assessment method that can be integrated in routine care of geriatric oncology patients to improve quality of life and compliance, and to decrease toxicity and costs.

Methods

Patients >65 years and with ≥5 chronic medications that visited our outpatient oncology clinic were offered a polypharmacy assessment by a clinical pharmacist. The polypharmacy assessment was based on the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) method and consisted of a polypharmacy anamnesis with the patient, a subsequent polypharmacy analysis, and an optimized polypharmacy treatment plan that was provided to the oncologist. In parallel, a geriatric assessment was performed using ACE-27, ECOG and G8 scoring systems to score comorbidity, performance and frailty, respectively.

Results

The OncoSTRIP polypharmacy assessment is now integrated as part of routine care of geriatric oncology patients in our hospital. At the time of the first analysis, 24 patients (17 male and 7 female; mean age 74.3 years) had undergone a polypharmacy assessment. The mean number of chronic medications, oncology medications, supportive medications and total medications was 8.0 (range 4-14), 2.3 (range 1-5), 2.4 (range 0-6) and 12.7 (range 6-21), respectively. Polypharmacy treatment optimization was proposed for 19 (79%) of patients, with a total of 26 suggested pharmacotherapeutic modifications. Mean time spent per patient was 53 minutes.

Conclusions

Polypharmacy assessment of geriatric oncology patients identifies many possible optimizations in pharmacotherapy. The OncoSTRIP method can be integrated in routine care of geriatric oncology patients. Supported by a grant from the Dutch Cancer Society.

Clinical trial identification

Not applicable.

Legal entity responsible for the study

N/A

Funding

Dutch Cancer Society

Disclosure

All authors have declared no conflicts of interest.