A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer.
OBJECTIVE
The prevalence of complementary and alternative medication (CAM) use in senior adult oncology (SAO) patients is widely variable and little is known about whether polypharmacy (PP) and potentially inappropriate medication (PIM) use influences CAM use given the increased number of comorbidities and polypharmacy. One approach to optimize medication management is through utilization of pharmacists as part of a team-based, healthcare model.


METHODS
Prevalence of CAM and factors influencing CAM use was examined in a secondary analysis of 248 patients who received an initial comprehensive geriatric oncology assessment between January 2011 and June 2013. Data was collected from electronic medical records. CAM was defined as herbal medications, minerals, or other dietary supplements, excluding vitamins. Patient characteristics influencing CAM use (e.g. comorbidities, PP and PIM use) were analyzed.


RESULTS
Only 234 patients (evaluated by pharmacists) were included in the final analysis. Mean age was 79.9 years [range 61-98]; 64% women, 74% Caucasian, 87% with a solid tumor, mean comorbidities, 7.69. CAM prevalence was 26.5% (n=62) and median CAM use was 0 (range 0-10). The proportion of CAM use (1, 2, and 3) was 19.2%, 6.4%, and 0.4%, respectively. Associations with CAM use (versus no-CAM) were polypharmacy (P=0.045), vision impairment (P=0.048) and urologic comorbidities (P=0.021).


CONCLUSIONS
A pharmacist-led comprehensive medication assessment demonstrated a more precise estimation of CAM prevalence in the ambulatory SAO population. CAM use was associated with polypharmacy, ophthalmic and urologic medical conditions. Integrating pharmacists into team-based (geriatric and oncology) care models is an underutilized yet viable solution to optimize medication use.
Department of Pharmacy Practice, Jefferson College of Pharmacy, Philadelphia, PA, USA. Electronic address: ginah.nightingale@jefferson.edu.
Ginah
G
Nightingale
Department of Pharmacy Practice, Jefferson College of Pharmacy, Philadelphia, PA, USA.
Emily
E
Hajjar
Department of Pharmacy Practice, Loma Linda University Medical Center, Loma Linda, CA, USA.
Krystal
K
Guo
Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
Stephanie
S
Komura
Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA.
Eric
E
Urnoski
Nonclincal Biostatistics, Janssen Research and Development, Spring House, PA, USA.
Jocelyn
J
Sendecki
Department of Family and Community Medicine, Division of Geriatrics and Palliative Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Kristine
K
Swartz
Department of Medical Oncology, Jefferson Senior Adult Oncology Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Andrew
A
Chapman
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000529:Complementary Therapies / Q000379:methods; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D010595:Pharmacists; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents
Cancer; Complementary medicine; Herbals; Medication use; Older adults; Polypharmacy