e22034 Background: Older patients (pts) with cancer have more chemotherapy (chemo) toxicities leading to dose modifications. Few studies have evaluated the association of concomitant medications (meds) and geriatric impairments with chemo dosing. This study examines the associations of medication measures [polypharmacy (PP), potentially inappropriate medications (PIM) and potential drug interactions (PDI)] and Geriatric Assessment (GA) impairments with relative dose intensity (RDI) of chemo in older adults with advanced cancer. Methods: A secondary analysis was conducted on the control arm of an ongoing prospective randomized study enrolling pts > 70 with advanced cancers on chemo. PP was defined as concurrent use of ≥5 meds at baseline. PIMs were categorized using 2012 Beers criteria and Screening Tool of Older Person’s Prescriptions (STOPP). PDI were reviewed using Lexi-Interact® Online with category D and X as major PDI. Pts underwent a GA at baseline evaluating PP, cognition, nutrition, physical function, comorbidities, mood, and social support. A score of 1 was given to an impaired domain (except for PP and comorbidity) and total score was generated. RDI was a ratio of received to standard dose of chemo for the first 3 months of therapy ( < 65 vs. ≥65%). Bivariate and multivariate logistic regressions analyses were performed controlling for covariates at P < 0.1. Results: Among 60 pts (mean age 77, 57% males, 87% stage IV, 33% had upfront dose reduction), mean number of meds was 8 (range 0-24). Mean number of GA impairment was 3. The prevalence of med measures was as follows: PP (83%), PIM by Beers (55%), PIM by STOPP (58%), major PDI not involving chemo (55%), and major PDI involving chemo (15%). 29% had RDI < 65%. Multivariate analysis showed that higher GA impairment score was associated with RDI < 65% (OR 0.52, P = 0.038). No med measures were associated with RDI < 65%. Conclusions: Older pts with cancer have high prevalence of PP/PIM/PDI, but these were not associated with lower dose intensity. Higher GA impairment score was associated with lower RDI reflecting the importance of GA in predicting chemo tolerance.
e20516 Background: PIM use in seniors is a public health problem linked to billions in health expenditures; cancer-related therapies further escalate its prevalence and complexity. Existing studies are limited by antiquated criteria and inherent pitfalls of patient self-report/chart extraction (versus a pharmacist-led assessment). Objectives: 1) Identify prevalence and associations with PIM use; 2) Determine the most inclusive PIM criteria. Methods: This retrospective study involved 248 patients (aged ≥ 60 years) referred for a geriatric-oncology assessment in January 2011 through June 2013 (data from physician/pharmacist electronic notes). Patients brought medications (prescription, non-prescription, herbals) for the pharmacist-led assessment. PIM use was determined by 2012 Beers, the Screening tool of older persons' potentially inappropriate prescriptions (STOPP) and the Healthcare and data information set (HEDIS) criteria. Results: Mean age was 79.9 years [range 61-98]; 64% women, 74% Caucasian, 87% solid tumor, mean comorbidities, 7.69); only 234 patients (evaluated by pharmacists) were included in the final analysis. PIM prevalence was 51% (n = 119). Beers, STOPP and HEDIS classified 173 PIMs equivalent to 8% of total medications (n = 2163). Mean PIM use was 0.74 (SD 0.89), range [(0-4)]. The proportion of PIMs used (0, 1, 2, 3, 4) was 49%, 34%, 12%, 4% and 1%, respectively. Significant associations with PIM use (versus no-PIM) were polypharmacy (P < 0.001) and increased comorbidities (P = 0.005), specifically cardiovascular (P = 0.014), gastrointestinal (P = 0.013), neurologic (P = 0.020), and psychiatric (P < 0.001) conditions. BEERs and STOPP were most inclusive capturing 120 (69%) and 119 (69%) PIMs versus 58 (34%) with HEDIS. 67 (39%) PIMs were jointly identified by Beers and STOPP. Conclusions: A pharmacist-led medication assessment identified a high prevalence of PIM use associated with polypharmacy and increased comorbidities. A modified PIM tool that integrates Beers and STOPP and considers cancer diagnosis, prognosis and cancer-related therapy is needed to identify and prevent PIM use in this vulnerable population.
Objective: To present the current clinical evidence on ofatumumab for use in refractory chronic lymphocytic leukemia (CLL). Data Sources: A literature search was performed using MEDLINE and PubMed (both 1966-May 2011), as well as the American Society of Hematology abstracts (2000-May 2011), using the primary search terms ofatumumab and HuMax-CD20, Study Selection and Data Extraction: Clinical studies and abstracts available in the English language, describing the pharmacology, pharmacokinetics, clinical activity, and safety of ofatumumab in CLL were included in this review. Data Synthesis: Ofatumumab is a human immunoglobulin monoclonal antibody that binds to B-lymphocytes expressing CD-20 cell surface antigens. Ofatumumab was granted accelerated approval by the Food and Drug Administration in October 2009 for the treatment of CLL refractory to fludarabine and alemtuzumab. A Phase 1/2 trial has established the safety and tolerability of single-agent ofatumumab at an initial dose of 300 mg intravenously on week 1, followed by 2000 mg once weekly for 7 doses (weeks 2–8), followed by 2000 mg once every 4 weeks for 4 doses (weeks 9–12), for a total of 12 doses. The final analysts of a pivotal international multicenter trial has shown promising activity in patients with CLL refractory to fludarabine and alemtuzumab, demonstrating overall response rates of 44–51 %, with prolonged progress ion-free and overall survival. Ofatumumab activity has also been shown in a variety of other malignant and nonmalignant conditions, including non-Hodgkin lymphoma, rheumatoid arthritis, and multiple sclerosis. The most common adverse effect is grade 1 and 2 infusion reactions. Other adverse effects include infection, neutropenia, anemia, rash, fever, and diarrhea. Conclusions: Clinical evidence suggests that ofatumumab is an effective agent in patients with CLL refractory to fludarabine and alemtuzumab. Data are awaited comparing ofatumumab to other salvage regimens. Until results of head-to-head trials are conducted comparing ofatumumab to existing regimens, it cannot be said whether ofatumumab is more efficacious or tolerable than currently available therapies.
Background: Medication-related problems in older Blacks with diabetes mellitus (DM) are not well established. Objectives: To describe the frequency of medication-related problems in older Blacks with DM presenting to the emergency department (ED). Methods: The study was a cross-sectional analysis of baseline data from a randomized controlled trial evaluating Blacks aged ≥60 years of age presenting to the ED. Polypharmacy, potentially inappropriate medication (PIM) use, and anticholinergic score were evaluated. Results: Of 168 patients (median age = 68, range 60–92), most ( n = 164, 98%) were taking ≥5 medications, and 67 (39.9%) were taking a PIM. A majority ( n = 124, 74%) were taking a medication with an anticholinergic score ≥1. Number of medications was correlated with number of PIMs ( r = .22, p = .004) and anticholinergic score ( r = .50, p < .001). Conclusion: Polypharmacy and PIM use was common in older Blacks with DM.
Abstract The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.
