Cancer co-medication quality in older patients with polypharmacy: A large randomized trial testing a medication review versus usual care.

BACKGROUND: Evidence from randomized controlled trials (RCTs) testing medication reviews in geriatric oncology is sparse. METHODS: We conducted a single-blinded RCT in ten rehabilitation clinics across Germany. Patients with common cancers, aged ≥ 65 years, and polypharmacy (regularly ≥ five drugs) were randomly allocated in equal proportions to usual care or a comprehensive pharmacist-led medication review conducted with the validated Fit fOR The Aged (FORTA) list. The FORTA score is the sum of drugs classified as potentially inappropriate medication (PIM) (each two points), drug underuse (each one point), and drug overuse (each one point). Changes in the FORTA score and its subcomponents from rehabilitation admission to discharge were tested using the chi-square test or the Wilcoxon's rank-sum test. FINDINGS: At admission, 66.1%, 94.6%, and 58.9% of 443 trial participants included in the intention-to-treat analysis were exposed to PIM, medication underuse, or overuse, respectively, and the median FORTA score was six. At discharge, participants of the intervention group (n = 234) had a statistically significant greater reduction in the mean FORTA score than the control group (n = 209): mean difference [95% confidence interval]: -3.7 [-4.2; -3.3] score points. Furthermore, the proportions of subjects with PIM, underuse, and overuse were statistically significantly reduced by the intervention by 41.3, 35.5, and 30.7 percentage points (all p < 0.001). INTERPRETATION: The pharmacist-led intervention with the FORTA list substantially improved the medication quality of older cancer patients with polypharmacy in clinical practice. A reduction of four FORTA score points (rounded) translates, for example, to the withdrawal of two PIMs or four drugs labeled overuse.