Rapid Fire Best of the Best Oral 2025 Joint Meeting of the COSA ASM and IPOS Congress

Polypharmacy and potentially inappropriate medication use: Opportunities for prescriber- and pharmacist-led deprescribing for cancer inpatients. (126534)

Sam Maleki 1 , Josephine Foo 1 , Deena Tumber 1 , Siena Bullen 2 , Kelly Cheung 2 , Mohammadali Mirzai 2 , Shanley Pillai 2 , Tiffany Xia 2 , Emily Schembri 3 , Justin Turner 2 , Wee Kheng Soo 3 4 5 , Carl Kirkpatrick 2
  1. Pharmacy Department, Eastern Health, Box Hill, Victoria, Australia
  2. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  4. Cancer Services, Eastern Health, Box Hill, Victoria, Australia
  5. Aged Medicine Program, Eastern Health, Box Hill, Victoria, Australia

Background: Polypharmacy and potentially inappropriate medications (PIMs) are associated with significant adverse health outcomes1, yet little is known about the process for reducing polypharmacy and PIMs in older Australians with cancer.

Aim: To examine the prevalence, characteristics, and deprescribing interventions related to polypharmacy and PIMs among cancer patients admitted to a metropolitan hospital in Victoria, Australia.

Methods: Adult oncology and haematology inpatients aged ≥65 years who received both admission pharmacy medication reconciliation and discharge medication list were included. Comparisons between admission and discharge data from January to December 2024 are presented, including: polypharmacy (≥5 medications), PIMs (defined using STOPP criteria), and deprescribing (medication cessation).

Results: Among 278 eligible patients (median age 77.0 years; range: 65-98; 44.6% female), polypharmacy increased from 79.1% to 92.4%. Median medication count increased from 8.0 (IQR 7.0) to 10.0 (IQR 7.0). Overall, 9.6% (234/2429) of medications were deprescribed: including 50.4% (118/234) for non-cancer comorbidities, 39.7% (93/234) supportive care (including 22.2% [52/234] for pain), and 8.1% (19/234) complementary/alternative medications. On admission, 32.4% (90/278) had at least one PIM (total PIMs=146), decreasing to 23.7% (66/278) on discharge (total PIMs=105). Pharmacist recommendations to deprescribe contributed to 29.5% of overall deprescribing and 92.6% of PIMs-related deprescribing. Top PIMs categories: undocumented indications (10.3%), missing laxatives with opioids (9.6%), missing short-acting opioids with long-acting opioids (8.9%) and opioid use in recurrent falls (6.8%).

Conclusions: The increase in polypharmacy likely reflects appropriate symptom management, while the reduction in PIMs suggests clinicians and pharmacists actively sought to reduce medication burden through targeted deprescribing. Although the most frequently identified PIMs were analgesics, these may not represent inappropriate prescribing but a mismatch between existing tools such as STOPP and complexities of cancer pain management. Further research is needed to support evidence-based deprescribing in cancer, including development of cancer-specific tools and clearer definitions of inappropriate polypharmacy.

  1. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741.