title: Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer.
abstract: OBJECTIVE
  The use of multiple and/or inappropriate medications in seniors is a significant public health problem, and cancer treatment escalates its prevalence and complexity. Existing studies are limited by patient self-report and medical record extraction compared with a pharmacist-led comprehensive medication assessment.
  
  
  METHODS
  We retrospectively examined medication use in ambulatory senior adults with cancer to determine the prevalence of polypharmacy (PP) and potentially inappropriate medication (PIM) use and associated factors. PP was defined as concurrent use of five or more and less than 10 medications, and excessive polypharmacy (EPP) was defined as 10 or more medications. PIMs were categorized by 2012 Beers Criteria, Screening Tool of Older Person's Prescriptions (STOPP), and the Healthcare Effectiveness Data and Information Set (HEDIS).
  
  
  RESULTS
  A total of 248 patients received a geriatric oncology assessment between January 2011 and June 2013 (mean age was 79.9 years, 64% were women, 74% were white, and 87% had solid tumors). Only 234 patients (evaluated by pharmacists) were included in the final analysis. Mean number of medications used was 9.23. The prevalence of PP, EPP, and PIM use was 41% (n = 96), 43% (n = 101), and 51% (n = 119), respectively. 2012 Beers, STOPP, and HEDIS criteria classified 173 occurrences of PIMs, which were present in 40%, 38%, and 21% of patients, respectively. Associations with PIM use were PP (P < .001) and increased comorbidities (P = .005).
  
  
  CONCLUSIONS
  A pharmacist-led comprehensive medication assessment demonstrated a high prevalence of PP, EPP, and PIM use. Medication assessments that integrate both 2012 Beers and STOPP criteria and consider cancer diagnosis, prognosis, and cancer-related therapy are needed to optimize medication use in this population.
authors: Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA. ginah.nightingale@jefferson.edu.
authors: Ginah
authors: G
authors: Nightingale
authors: Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA.
authors: Emily
authors: E
authors: Hajjar
authors: Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA.
authors: Kristine
authors: K
authors: Swartz
authors: Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA.
authors: Jocelyn
authors: J
authors: Andrel-Sendecki
authors: Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA.
authors: Andrew
authors: A
authors: Chapman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D010595:Pharmacists; D015143:Philadelphia; D019338:Polypharmacy; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents