Interprofessional, risk-adapted medication management in older patients with cancer (IrMa)

Older patients with cancer are at increased risk for adverse drug events due to chronic conditions and complex medication regimens often leading to polymedication. A pharmacist-led medication review has the potential to reduce drug-related problems and enhance medication safety. Oncogeriatric scores are effective in predicting chemotherapy-associated toxicity. However, risk scores are only of benefit for the patient if the results lead to therapeutic consequences. This study aimed to develop and evaluate an interprofessional risk-adapted medication management intervention (IrMa) to reduce the symptom burden caused by adverse drug events in older patients with cancer.

The individualized care approach entailed adapting the intensity of care to the toxicity risk of each patient. This was determined prior to tumor therapy by using the Cancer and Aging Research Group (CARG) score and existing polymedication. Based on their individual risk, patients were divided into different groups and received either standard care ("low-risk patients"), or, for high-risk patients, symptom counseling, medication review, or both. Feasibility and acceptability of the intervention were investigated as primary outcome. Toxicity and patient-reported symptom burden were documented and analyzed as secondary outcomes. A non-inferiority analysis was conducted to assess whether high-risk patients who received the IrMa intervention experienced a similar level of toxicity or symptom burden as low-risk patients, despite their higher risk. This analysis aimed to identify preliminary efficacy signals.

The intervention was feasible and well accepted. Out of 101 enrolled patients, 96 patients aged between 70 and 88 years were stratified. Implementation rates were 100% for medication reviews and 74% for symptom counseling. Of the identified drug-related problems requiring intervention, 73.9% were resolved. In the first cycle, the overall toxicity rate (CTCAE grade ≥ 3) was 67.5% in low-risk patients and 80.4% in high-risk patients. Preliminary efficacy signals were identified for patient-reported mucositis, vomiting, constipation and diarrhea in the first cycle but not for toxicity grade ≥ 3.

The interprofessional, risk-adapted medication management for older patients with cancer is a feasible and accepted approach to improve patient safety. Patient-reported outcomes indicate a preliminary efficacy in reducing symptoms that can be influenced by appropriate supportive care.