# Structured deprescribing review at cancer diagnosis and again at transition to palliative care

Source: https://onco.cc/ideas/idea-acc-structured-deprescribing-at-diagnosis/  
OnCo record `idea-acc-structured-deprescribing-at-diagnosis` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Older cancer patients often take ten or more medicines, some of which no longer help and may interact with cancer treatment. A pharmacist review to stop unnecessary ones, at diagnosis and when goals change, would reduce harm.

## Summary

Polypharmacy is common in older patients with cancer and is associated with toxicity, falls, and hospitalisation. Preventive medicines with long time-to-benefit (statins in limited prognosis, tight glycaemic control, bisphosphonates for osteoporosis in the last year of life) can be stopped. Evidence-based deprescribing algorithms exist for many drug classes. A protocolised pharmacist-led review at two defined points would apply them systematically.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Structured deprescribing will reduce the mean number of medicines by at least two per patient and reduce adverse drug events and falls by at least 20%, without increasing symptom burden.
- Rationale: Deprescribing trials in geriatrics show safety and modest benefit; oncology adds a clear prognostic frame that makes stopping easier to justify.
- Proposed test: A randomised trial in 600 patients over 70 with adverse drug events, falls, quality of life, and medicine counts as endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Deprescribing.org algorithms: https://deprescribing.org/

## Connected records

- ideas: [Oncology pharmacists as protocol prescribers for supportive care and dose adjustments](https://onco.cc/ideas/idea-acc-oncology-pharmacist-prescribing/), [Pharmacist interaction check before every oral cancer-drug prescription](https://onco.cc/ideas/idea-acc-pharmacist-interaction-review-oral-anticancer/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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