Deprescribing interventions in older adults with cancer: A systematic review and meta-analysis

Abstract

Introduction Polypharmacy and use of potentially inappropriate medications (PIMs) in older adults with cancer are associated with increased morbidity and mortality. Deprescribing is a structured, patient-centred intervention for reducing PIMs; however, the outcomes of deprescribing interventions in cancer care remain unclear. We aimed to evaluate the impact of deprescribing interventions on PIM exposure and downstream patient-centred outcomes in older adults with cancer. Materials and methods A systematic review and meta-analysis of original studies indexed in MEDLINE, Embase, and CENTRAL was conducted, evaluating deprescribing interventions in adults aged ≥65 years with cancer. Meta-analysis quantified changes in the proportion of patients with ≥1 PIM. Data were synthesised narratively, with random-effects meta-analysis performed where appropriate. Results Eight studies involving 1018 participants (range 26–392) were included, predominantly uncontrolled pre–post service evaluations conducted in inpatient or outpatient settings. All involved a clinical pharmacist, often within a multidisciplinary team. Four studies ( n = 365) reported PIM deprescribing rates, ranging from 62.5% to 73%. Meta-analysis of three studies ( n = 189) showed deprescribing reduced the proportion of patients with ≥1 PIM (pooled RR 0.49; 95% CI 0.36–0.66; I 2 = 0.0%). Evidence for broader patient-centred outcomes was limited and primarily narrative. Discussion Deprescribing interventions in older adults with cancer appear feasible and are associated with reduced inappropriate medication use. However, confidence in this finding is limited by the small number of studies with serious risk of bias. Evidence for patient-centred outcomes remains limited, highlighting a critical evidence gap in geriatric oncology and the need for high-quality, cancer-specific interventions evaluated using clinically meaningful outcomes.