Pharmacist-led deprescribing interventions for cancer patients in a specialist palliative care setting

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Date
2025-03-26
Authors
McAdam, Ciarán
O’Dwyer, Eimear
Dalton, Kieran
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Volume Title
Publisher
Springer Nature
Published Version
10.1007/s00520-025-09341-9
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Abstract
Purpose: This study aimed to determine the prevalence of potentially inappropriate medications (PIMs) among adult cancer patients in palliative care, the rate at which physicians implemented pharmacists’ deprescribing recommendations, and some cost implications of deprescribing. Methods: Medication reconciliation was performed for each eligible patient, with both the OncPal deprescribing guideline and clinical judgement applied to identify PIMs. PIM prevalence was evaluated for each medication class. The physician recommendation implementation rate and medication cost savings were calculated. Results: In the 48 included patients, 25.2% of medications were PIMs (mean 2.4/patient) - with 86.7% OncPal-defined PIMs, most commonly vitamins, medications for gastro-oesophageal reflux disease (GORD), and lipid-modifying agents. Pharmacist deprescribing recommendations were implemented 71.7% of the time, equivalent to 1.7 fewer medications per patient. The 28-day cost was €948.27 for deprescribed PIMs. Implementation rates varied based on patient admission type, with a significantly higher (p<0.05) rate in those admitted for end-of-life care (83.3%) versus symptom control (65.1%) and respite (30%) admissions. Recommendations to deprescribe GORD medications had a significantly lower rate of implementation (26.7%) compared to all other medications (p<0.0001). Conclusion: This study underscores the benefits of pharmacist-led deprescribing in inpatient palliative care, resulting in cost savings and reduced medication burden. There is a notable need for proactive deprescribing before reaching inpatient care. Different deprescribing rates across medication types highlight the significance of reviewing medications which may have a role in symptom management. The omission of some medications from OncPal emphasises the importance in refining future deprescribing guidelines in palliative care.
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Keywords
Drug therapy , Pharmacy , Pharmacoeconomics , Pharmacotherapy , Pharming , Drug portfolio management
Citation
McAdam, C., O’Dwyer, E. and Dalton, K. (2025) 'Pharmacist-led deprescribing interventions for cancer patients in a specialist palliative care setting', Support Care in Cancer, 33, 321 (10pp). https://doi.org/10.1007/s00520-025-09341-9
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https://hdl.handle.net/10468/17752
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Pharmacy - Journal Articles
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© 2025, the Authors. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.