Using the Geriatric Oncology Potentially Inappropriate Medications scale (GO-PIMs), researchers found that older adults are likely to be taking a number of potentially inappropriate or high-risk medications that are associated with increased frailty at the time of their cancer diagnosis, according to findings from a retrospective cohort study published in JNCCN—Journal of the National Comprehensive Cancer Network.
“This research is about making treatment safer and more tolerable—especially for older adults who are already vulnerable to adverse events,” explained lead author Jennifer La, PhD, of Harvard Medical School and the Veterans Affairs (VA) Boston Cooperative Studies Program Center. “We found that many patients are prescribed chronic and supportive care medications that may do more harm than good—especially when they’re already dealing with complex health issues. These medications, rapidly identified by the GO-PIMs scale, were linked to higher rates of frailty, hospitalizations, and even death. By identifying and reviewing these prescriptions early, we can potentially improve safety and outcomes for people undergoing cancer treatment.”
Background and Study Methods
Older adults with cancer are typically taking multiple chronic medications, with recent systematic reviews estimating that 74% to 80% of older adults with cancer were taking multiple prescription drugs.
Potentially inappropriate medications are drugs that may cause more potential harm than possible benefit, especially in older patients. Guidelines from ASCO and the National Comprehensive Cancer Network (NCCN) recommend reviewing potentially inappropriate medications to improve outcomes and reduce frailty in older patients.
Researchers from the VA Healthcare System in Boston evaluated the GO-PIMs scale as a tool to identify high-risk medications for older adults with cancer and assess resulting risks. The tool, which is based on information on high-risk medications from the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®) for Older Adult Oncology, was previously validated for measuring frailty among older patients with hematologic malignancies.
The investigators used data from the VA Cancer Registry of 388,113 older adults who were newly diagnosed with cancer, both solid tumors and hematologic malignancies, between 2000 and 2022. They looked at prescriptions filled by patients in the 90 days before their initial diagnoses to determine the amount of potentially inappropriate medications that they were on prior to the cancer diagnosis and to assess how frail they were at diagnosis, using the VA Frailty Index categorizations.
Key Study Findings
The study found that 38% of older patients with cancer were prescribed at least one potentially inappropriate medication, which most commonly included selective serotonin reuptake inhibitors.
Each subsequent high-risk medication was associated with a 66% greater risk of experiencing mild or moderate-to-severe frailty at the time of cancer diagnosis (adjusted odds ratio = 1.66; 95% confidence interval [CI] = 1.65–1.67).
Additional high-risk medications were also associated with higher risks for unplanned hospitalizations (adjusted hazard ratio [aHR] = 1.08; 95% CI = 1.07–1.08) and for death (aHR = 1.07; 95% CI = 1.06–1.07), after adjusting for frailty and covariates.
“We hope this research encourages oncology teams to routinely review medication lists—not just count the number of drugs but look closely at which ones might be risky,” said senior author Clark DuMontier, MD, MPH, of Harvard Medical School and VA Boston/Brigham and Women’s Hospital/Dana-Farber Cancer Institute. “Tools like the GO-PIMs scale can be built into electronic health records to flag concerning prescriptions. We need to weigh the risks and benefits carefully, and when possible, consider safer alternatives or deprescribing. Finding the right balance requires individual considerations for each patient, and we hope tools like GO-PIMs and frailty assessment will help make that possible. We are currently piloting such an approach using GO-PIMs in our local clinic.”
Expert Commentary
In an editorial commenting on the study, Mostafa Mohamed, MBBCh, PhD, MSc, of the University of Rochester Medical Center, and colleague Erika E. Ramsdale, MD, noted that although the study by La et al highlights well a particular issue among older patients with cancer, standardized lists of potentially inappropriate medications often lack specificity.
“A cancer diagnosis is an ideal time to revisit medication safety, as older adults often begin systemic therapy with complex regimens, shifting goals of care, and frequent clinical contact,” Dr. Mohamed commented. “La et al highlighted the increased prevalence and clinical relevance of potentially inappropriate prescribing in older adults with cancer using the GO-PIMs scale in a national dataset. This analysis is unique in its use of a cancer-specific PIMs framework (GO-PIMs) derived from NCCN Guidelines in a real-world, national setting.
Dr. Mohamed continued: “This research underscores the opportunity to improve care by addressing medication-related risks. The next step is integrating tools like GO-PIMs into everyday practice, not only to flag high-risk medications, but also to support actionable changes in treatment planning and patient care.”
La et al recommended integrating GO-PIMS into electronic health records data for greater accessibility, as has been done within the VA's system. The study authors are currently piloting the ability of the integration to assist clinicians and pharmacists in identifying high-risk medications that could be changed to improve patient outcomes.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
