4CPS-349 Role of hospital pharmacists in oncogeriatric consultations: a retrospective study

• Published in: European journal of hospital pharmacy. Science and practice Vol. 28; no. Suppl 1; p. A89
• Main Authors: Ruppert, L, Mortier, CP, Lelievre, I, Phan, B
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.03.2021
• Subjects: Conflicts of interest; Pharmacists
• DOI: 10.1136/ejhpharm-2021-eahpconf.181
• ISSN: 2047-9956

Background and importancePopulation aging and the growing risk of developing cancer with age lead to an increasing number of elderly patients treated in the oncology care unit. Elderly people are fragile, polypathological and polymedicated. To optimise their care, oncogeriatric consultations are performed by a doctor, nurse, dietician and psychologist.Aim and objectivesThe aim of this study was to evaluate the benefit of including the hospital pharmacist in these consultations.Material and methodsA retrospective study was conducted on 17 patient files that had been reviewed in oncogeriatric consultations at our hospital centre from May 2019 to March 2020. We searched for information on each patient in the electronic medical record: medical background, usual treatments, considered cancer therapy, biological results, risk of falling, and the presence of balance and cognitive disorders. We then analysed drug interactions, identified potentially inappropriate prescriptions according to the STOPP and START criteria and the anticholinergic burden of the treatment.ResultsAverage age was 84 and the male/female ratio was 0.55. 62 pharmaceutical interventions could have been transmitted to the doctor if the pharmacist had participated in these consultations (ranging from 3 to 6 interventions per patient, average 3.65). There were 7 types: addition of treatment (21), monitoring to be programmed remotely from the consultation (10), dosage adjustments (7), treatment discontinuation (7), biological monitoring (7), adaptation of the intake plan (6) and molecule switch (4). The main interventions were: management of vitamin deficiencies (D, B9, B12), anti-pneumococcal vaccination, discontinuation of drugs with formal contraindications or belonging to the same therapeutic class, high dose PPIs without indication, benzodiazepines dose adjustment, monitoring of nephrotoxicity and serum potassium, replacement of one benzodiazepine by another with a shorter half-life and adaptation of the intake plan to limit interactions between oral chemotherapy and antacid.Conclusion and relevanceThe pharmacist has a real role to play in oncogeriatric consultations, to prevent iatrogeny and optimise patient care. The limitations of the study were the non-exhaustiveness of the treatment (self-medication and phytotherapy), ignorance of potential swallowing disorders and vaccinations carried out. However, this missing information can impact on patient care and could be collected by the hospital pharmacist.References and/or acknowledgementsConflict of interestNo conflict of interest