A pharmacist-led medication assessment to identify prevalence and associations with potentially inappropriate medications (PIMs) in ambulatory senior adults with cancer.

e20516 Background: PIM use in seniors is a public health problem linked to billions in health expenditures; cancer-related therapies further escalate its prevalence and complexity. Existing studies are limited by antiquated criteria and inherent pitfalls of patient self-report/chart extraction (versus a pharmacist-led assessment). Objectives: 1) Identify prevalence and associations with PIM use; 2) Determine the most inclusive PIM criteria. Methods: This retrospective study involved 248 patients (aged ≥ 60 years) referred for a geriatric-oncology assessment in January 2011 through June 2013 (data from physician/pharmacist electronic notes). Patients brought medications (prescription, non-prescription, herbals) for the pharmacist-led assessment. PIM use was determined by 2012 Beers, the Screening tool of older persons' potentially inappropriate prescriptions (STOPP) and the Healthcare and data information set (HEDIS) criteria. Results: Mean age was 79.9 years [range 61-98]; 64% women, 74% Caucasian, 87% solid tumor, mean comorbidities, 7.69); only 234 patients (evaluated by pharmacists) were included in the final analysis. PIM prevalence was 51% (n = 119). Beers, STOPP and HEDIS classified 173 PIMs equivalent to 8% of total medications (n = 2163). Mean PIM use was 0.74 (SD 0.89), range [(0-4)]. The proportion of PIMs used (0, 1, 2, 3, 4) was 49%, 34%, 12%, 4% and 1%, respectively. Significant associations with PIM use (versus no-PIM) were polypharmacy (P < 0.001) and increased comorbidities (P = 0.005), specifically cardiovascular (P = 0.014), gastrointestinal (P = 0.013), neurologic (P = 0.020), and psychiatric (P < 0.001) conditions. BEERs and STOPP were most inclusive capturing 120 (69%) and 119 (69%) PIMs versus 58 (34%) with HEDIS. 67 (39%) PIMs were jointly identified by Beers and STOPP. Conclusions: A pharmacist-led medication assessment identified a high prevalence of PIM use associated with polypharmacy and increased comorbidities. A modified PIM tool that integrates Beers and STOPP and considers cancer diagnosis, prognosis and cancer-related therapy is needed to identify and prevent PIM use in this vulnerable population.