INTRODUCTION: Polypharmacy (concurrent use of ≥ 5 medications) is common in patients with non-small cell lung cancer and increases the risk of potentially inappropriate medication use, particularly in those with advanced disease. Deprescribing may reduce medication-related harm; however, its implementation in oncology remains limited and is insufficiently informed by stakeholder perspectives. AIM: This study aimed to determine the prevalence of potentially inappropriate medications in patients with advanced non-small cell lung cancer and explore the attitudes and beliefs of patients, caregivers, and healthcare professionals regarding deprescribing to inform feasible implementation strategies for routine clinical practice. METHOD: A retrospective analysis was conducted in a cohort of 817 patients with stage IV non-small cell lung cancer to identify potentially inappropriate medications using the OncoSTRIP checklist. Perspectives on deprescribing were collected using validated questionnaires: the revised Patients' Attitudes Toward Deprescribing (rPATD) for patients and caregivers and the Comprehensive Healthcare Providers' Opinions, Preferences, and Attitudes Toward Deprescribing (CHOPPED) for medical clinicians and pharmacists, which were completed by 37 patients, 15 caregivers, 24 medical clinicians (physicians and specialist nurses), and 24 pharmacists. RESULTS: Potentially inappropriate medications were algorithm-flagged in 793 of the 817 (97.1%) patients. Among these, 1,686 (40.8%) were confirmed by clinical evidence, while 2,448 (59.2%) were unconfirmed (defined as medications flagged by the checklist but lacking sufficient electronic health record data, such as laboratory values or specific indications, to definitively justify their use). The primary classifications were the risk of adverse drug events (47.3%) and unnecessary therapy (30.0%). Most patients (33, 89.2%) and caregivers (11, 73.3%) were willing to discontinue their medications if advised by a physician. Perceived barriers influenced medical clinicians' and pharmacists' willingness: medical clinicians were most affected by collaboration- and competence-related concerns, whereas pharmacists were constrained by competence- and patient-related factors. CONCLUSION: The high algorithm-flagged prevalence of potentially inappropriate medications with 40.8% confirmed by clinical evidence, in patients with advanced non-small cell lung cancer underscores the urgent need for deprescribing. Successful implementation requires a patient-centered approach, active involvement of patients and caregivers, interprofessional collaboration, and targeted strategies to address systemic and professional barriers to ensure safe and sustainable medication optimization.
Vries et al. (Wed,) studied this question.