Optimising Medications for Patients With Cancer and Multimorbidity: The Case for Deprescribing

J P Turner; K Kantilal; K Kantilal; H M Holmes; B Koczwara

doi:10.1016/j.clon.2020.05.015

Optimising Medications for Patients With Cancer and Multimorbidity: The Case for Deprescribing

Clin Oncol (R Coll Radiol). 2020 Sep;32(9):609-617. doi: 10.1016/j.clon.2020.05.015. Epub 2020 Jun 17.

Authors

J P Turner¹, K Kantilal², K Kantilal³, H M Holmes⁴, B Koczwara⁵

Affiliations

¹ Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada; Centre de Recherche de L'Institut Universitaire de Gériatrie de Montréal, Québec, Canada; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia. Electronic address: [email protected].
² School of Pharmacy, University of East Anglia, Norwich, UK.
³ Pharmacy Department, Northwick Park Hospital, Harrow, London, UK.
⁴ McGovern Medical School, The University of Texas Health Science Centre at Houston, Texas, USA.
⁵ Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia.

PMID: 32563549
DOI: 10.1016/j.clon.2020.05.015

Abstract

The majority of patients diagnosed with cancer are aged over 65 years and have two or more chronic conditions in addition to cancer and the risk of chronic conditions increases further after cancer. The presence of multimorbidity adds complexity to care, as patients' goals of care and the focus of treatment can change with a diagnosis of cancer. Multimorbidity is frequently associated with polypharmacy, the use of potentially inappropriate medications, the presence of adverse drug reactions and potential drug-drug interactions: all of which impact on health outcomes and the cost of care. Consequently, it is vital that a systematic approach is taken to regularly review cancer patients' medication regimens to ensure that they support an optimal balance of benefits with acceptable levels of harm. Several patient and clinician resources are presented to guide the process of medication review and deprescribing.

Keywords: Clinical oncology; deprescribing; multimorbidity and cancer; polypharmacy; potentially inappropriate medications.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Decision Making*
Deprescriptions*
Drug-Related Side Effects and Adverse Reactions / prevention & control*
Humans
Multimorbidity*
Neoplasms / drug therapy*
Patient-Centered Care / standards
Polypharmacy*
Potentially Inappropriate Medication List / standards*

Grants and funding

CIHR/Canada