Optimizing Polypharmacy in Older Adults With Cancer Through Physician Advisory Medication Reviews

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  Journal of Internal Medicine  https://doi.org/10.1111/joim.70161 
Dr. Miriam Degen et al.

Points

Researchers conducted a randomized controlled trial including four hundred forty three cancer patients aged sixty five and older taking five or more regular medications.
The pharmacist-led intervention provided advisory letters to physicians detailing comprehensive medication reviews guided by the Fit FOR The Aged list during rehabilitation.
Results demonstrated significant decreases in potentially inappropriate prescriptions, medication overuse, and medication underuse compared to standard care cohorts.
The comprehensive review identified three hundred thirty seven missing vaccinations for influenza, pneumonia, COVID nineteen, and shingles among intervention participants.
Authors concluded that pharmacist consultation is highly feasible and effectively improves overall co-medication quality for older cancer patients experiencing polypharmacy.

Summary

This study evaluated the efficacy and feasibility of a pharmacist-led comprehensive medication review utilizing the Fit FOR The Aged (FORTA) list to optimize co-medication in older cancer patients undergoing rehabilitation. Published in the Journal of Internal Medicine, the randomized controlled trial addressed the critical need to reduce medication-related problems in older oncology patients experiencing polypharmacy. The research sought to determine whether sending an advisory letter detailing review findings to attending physicians could effectively reduce potentially inappropriate medications (PIMs), medication overuse, and medication underuse in oncological rehabilitation settings.

The trial included 443 participants aged $\ge$65 years who were regularly taking $\ge$5 medications. At trial completion, the intervention group demonstrated substantial reductions in medication management issues compared to usual care: potentially inappropriate prescriptions were present in 29.9% versus 70.8% of patients, medication overuse occurred in 34.2% versus 64.1%, and medication underuse was documented in 44.9% versus 73.2%, respectively. Furthermore, a rounded four-point reduction in the FORTA score corresponded to the withdrawal of two PIMs or four overused drugs. The intervention also identified and recommended 337 missing vaccinations against influenza, pneumonia, COVID-19, and shingles.

The authors conclude that integrating a pharmacist-led comprehensive medication review into oncological rehabilitation wards is highly feasible and significantly improves medication quality. By providing actionable guidance via physician advisory letters, the strategy successfully mitigates polypharmacy risks, reduces PIMs, and addresses crucial preventive care gaps. These findings support routine implementation of pharmacist-physician collaboration to optimize therapeutic regimens in older cancer populations.

Link to the article: https://onlinelibrary.wiley.com/doi/10.1111/joim.70161

References

Degen, M., Kopp‐Schneider, A., Vlaski, T., Carlsson, S., Hallermann, P., Jewlanowa, L., Barinoff, J., Goede, V., Lüders, C., Kiefer‐Trendelenburg, T., Lüftner, D., Doll, J., Wagner, J., Leibbrand, B., Brenner, H., & Schöttker, B. (2026). Cancer co‐medication quality in older patients with polypharmacy: A large randomized trial testing a medication review versus usual care. Journal of Internal Medicine, joim.70161. https://doi.org/10.1111/joim.70161