Health professionals’ perspectives regarding polypharmacy in older patients with cancer : a mixed-design exploratory study

Objectives: Older patients with cancer often present with multimorbidity and polypharmacy, but there is little information on the challenges these conditions raise.We aimed to describe health professionals' practice, perceptions and needs related to polypharmacy for older adults receiving cancer treatment. Materials and Methods: We performed a mixed-design exploratory study. Phase 1 involved an online survey of 16 Likert-scale or multiple choices questions regarding polypharmacy and medication management for older patients with cancer. Phase 2 comprised two focus groups with oncology health professionals to learn about their perceptions and needs regarding medication management during cancer treatments. Results: A total of 54 health professionals responded to the survey (nurses = 25; pharmacists = 21; physicians = 6; other = 2). Half of them always or often felt that medication is a significant burden for patients but only a quarter always or often addressed the possibility of stopping medications. Ten health professionals participated in the focus groups. The normalization of the quantity of medications used in relation with aging, as well as the lack of older adults' knowledge about their medication were reported. Other barriers to deprescribing included lack of time and expertise, and issues with communication between health professionals. Conclusion: Although polypharmacy is a concern for many health professionals, most do not discuss deprescribing with older patients with cancer. Normalization of medication use, both by older adults and health professionals, stands as a significant barrier to critical medication review. The development of clinical tools could facilitate identification of circumstances where deprescribing is appropriate and help reduce associated barriers