Deprescribing practices in older adults with cancer: a narrative Review by the British Oncology Pharmacy Association Geriatric Oncology Specialist Advisory Group

Older adults with cancer can be burdened by complex medication regimens due to the need for systemic anti-cancer treatments (SACT), supportive medications, and drugs for managing comorbid conditions. Deprescribing, the systematic process of identifying and discontinuing medications that may no longer be necessary or could be harmful, has emerged as a crucial strategy in optimising care for adults with cancer. This narrative review aims to explore the current tools, and guidelines available for deprescribing in older adults with cancer, highlighting the benefits and challenges associated with this practice. By examining the existing literature, we seek to provide a comprehensive overview of how deprescribing can be effectively integrated into clinical practice to enhance the quality of care for adults with cancer in both the curative and non-curative settings.Deprescribing in older adults receiving cancer treatment with curative intent is a vital but underutilised strategy to reduce polypharmacy-related risks and optimise functional capacity during therapy. Deprescribing in older adults with advanced, progressive or incurable cancer could be based on their prognosis, life expectancy, comorbidities, and/or frailty status.The necessary skills, knowledge and behaviours required to support deprescribing in older adults with cancer will depend on practitioner role and specialism. Deprescribing in older adults with cancer undergoing curative therapy is a clinically justified, evidence-supported practice that enhances therapeutic resilience and reduces medication harm. Deprescribing in older adults with cancer who have a poor prognosis is an evidence-based, ethical, and person-centred practice that addresses the pervasive issue of polypharmacy.