Evaluating the impact of pharmacist interventions in the geriatric oncology setting

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dc.contributor.advisorSahm, Laura
dc.contributor.advisorO'Driscoll, Michelle
dc.contributor.advisorexternalHorgan, Anne M.
dc.contributor.authorBreathnach, Darren Joseph Henryen
dc.date.accessioned2026-05-19T14:55:01Z
dc.date.available2026-05-19T14:55:01Z
dc.date.issued2025-11-06
dc.date.submitted2025-11-06
dc.description.abstractIntroduction Older adults can have increasingly complex care needs, especially in the presence of multimorbidity and/or frailty. The addition of a cancer diagnosis, and the prospect of treating cancer, either with surgery, radiotherapy or systemic therapy (any pharmacological therapy) adds to the healthcare burden placed upon patients. Older adults with cancer are at an increased risk of systemic anticancer therapy toxicity (SACT). An integrated approach to managing the complex healthcare needs of older adults is part of national policy in Ireland, through the National Integrated Care Framework for Older Persons in community healthcare, and the emergence of rapid-access frailty services in acute care. In the field of medical oncology, the growing specialty of geriatric oncology incorporates a comprehensive geriatric assessment (CGA), and multidisciplinary approach, with a view to assessing, and overcoming, potential barriers to optimal cancer care. Nationally, there is strategic ambition to enhance care for older adults with cancer, as evidenced in the National Cancer Strategy 2017-2026. The role of the pharmacist in this setting has yet to be extensively explored, and the potential impact of integrating a pharmacist into the geriatric oncology multidisciplinary team is yet unknown. Aim To assess the impact of the integration of a pharmacist into the Geriatric Oncology Assessment and Liaison (GOAL) Clinic in University Hospital Waterford (UHW), as measured by the incidence of unplanned hospitalisation due to adverse drug events (ADE) in patients who attend the clinic. Methods A systematic review of the literature was undertaken to identify the incidence of unplanned hospitalisation due to ADE in older adults with cancer. This was followed by an assessment of the impact of SACT on polypharmacy status and unplanned hospitalisation, and the length of hospital stay in older adults with cancer compared to the general population. A retrospective analysis of older patients (aged ≥70 years) who attended a medical oncology outpatient appointment was undertaken to determine the incidence of (i) unplanned hospitalisation and (ii) unplanned hospitalisation due to ADE. A novel intervention, using a pragmatic adaptive iterative process, was employed to design and implement a comprehensive intervention, comprising of a patient-centred medication review process, delivered by the pharmacist in the GOAL clinic. Post intervention, a prospective study assessing the incidence of (i) unplanned hospitalisation and (ii) unplanned hospitalisation due to ADE was then conducted. The results of the retrospective and prospective studies were compared. Results The systematic review found a paucity of published literature focused on unplanned hospitalisation due to ADE in the older adult population with cancer. The average length of stay for an older adult with cancer was approximately double that of the general population. SACT increased unplanned hospitalisation when it contributed to a change in polypharmacy status. In the retrospective analysis of 174 patients, 43% (n=75) had an unplanned hospitalisation, with 24% (n=42) having an unplanned hospitalisation due to ADE. Polychemotherapy was the only statistically significant independent predictor of unplanned hospitalisation due ADE. In the prospective interventional study (n=240), after a structured medication review, CGA and multidisciplinary team (MDT) input, 39% of patients (n=93) had an unplanned hospitalisation, with 10% of patients (n=24) having an unplanned hospitalisation due to ADE. Polychemotherapy, performance status, and potentially inappropriate medication (PIM) were independent predictors of unplanned hospitalisation due to ADE. There was a statistically significant 65% risk reduction (p<0.001) between unplanned hospitalisation due to ADE in the prospective study in comparison to the retrospective study. Conclusion A pharmacist as an integrated member of a geriatric oncology MDT, and delivering a comprehensive medication review, can effectively identify potential medication related problems in older adults with cancer. This can lead to a significant reduction in the incidence of unplanned hospitalisation due to ADE.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationBreathnach, D. J. H. 2025. Evaluating the impact of pharmacist interventions in the geriatric oncology setting. PhD Thesis, University College Cork.
dc.identifier.endpage313
dc.identifier.urihttps://hdl.handle.net/10468/18787
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2025, Darren Joseph Henry Breathnach.
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.subjectPharmacy
dc.subjectClinical pharmacy
dc.subjectOncology
dc.subjectGeriatric oncology
dc.subjectMedication optimisation
dc.titleEvaluating the impact of pharmacist interventions in the geriatric oncology setting
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD - Doctor of Philosophyen
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