Cancer co-medication quality in older patients with polypharmacy: A large randomized trial testing a medication review versus usual care.
Miriam Degen, Annette Kopp-Schneider, Tomislav Vlaski et al.
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In 30 seconds
This multicentre, single-blinded randomised controlled trial tested a pharmacist-led medication review using the FORTA list versus usual care in patients aged ≥ 65 years with common cancers and polypharmacy at ten German rehabilitation clinics. Among 443 participants in the intention-to-treat analysis, the intervention produced a greater reduction in mean FORTA score by discharge than usual care: mean difference -3.7 [-4.2; -3.3] score points. The intervention also reduced the proportions of participants with potentially inappropriate medication, underuse, and overuse, indicating improved medication quality in this setting.
Key findings
- At admission, 66.1% had potentially inappropriate medication, 94.6% medication underuse, and 58.9% medication overuse; median FORTA score was six.
- By discharge, mean FORTA score reduction was greater with intervention than usual care: mean difference -3.7 [-4.2; -3.3] score points.
- The intervention reduced the proportions with potentially inappropriate medication, underuse, and overuse by 41.3, 35.5, and 30.7 percentage points, respectively (all p < 0.001).
Why it matters
Medication problems were common in this older cancer population with polypharmacy, and a structured pharmacist-led review improved a composite measure of medication quality during rehabilitation. The findings highlight the potential value of systematically assessing both inappropriate prescribing and medication underuse, rather than focusing only on reducing the number of medicines.
What to keep in mind
The study assessed medication quality from rehabilitation admission to discharge; the abstract does not report longer-term outcomes or whether score improvements affected clinical events.