Structured deprescribing review at cancer diagnosis and again at transition to palliative care
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.
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.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
Pages like this
not linked directly; found by shared links- IdeaA standard handoff with medication reconciliation at every cancer care transition
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- IdeaReport time toxicity, the days spent in healthcare, as a standard outcome for older patients
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- IdeaHospital-at-home for oncology: treating low-risk febrile neutropenia and dehydration at home
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- InstitutionWilmot Cancer Institute, University of Rochester
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- IdeaGeriatric assessment by default for every patient over 70 starting cancer treatment
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- Key paperGAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
- InstitutionMultinational Association of Supportive Care in Cancer
Shares Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.