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Background: Older adults often have chronic diseases for which they receive multiple drugs, which may be potentially inappropriate. Objectives: We aimed to describe the potentially inappropriate medications (PIMs) leading to adverse drug events (ADEs) in older patients with cancer. Our secondary objectives were to evaluate the association of nutrition, cognition, and frailty with PIM-related ADEs and to assess the impact of PIM-related ADEs on overall survival (OS). We also investigated the cut-off for defining polypharmacy as related to ADEs. Materials and Methods: This was a retrospective observational study on patients with cancer aged 60 years and over who were assessed in the geriatric oncology clinic at the Tata Memorial Hospital (Mumbai, India) from June 2018 to August 2022. Medications, PIM assessment, nutrition (assessed by Mini Nutritional Assessment [MNA]), cognition (assessed by Mini Mental State Examination [MMSE] and Hindi Mental State Examination), and frailty (assessed by the Clinical Frailty Scale [CFS]) were extracted from the geriatric oncology clinic database. PIMs were identified using the Beers criteria, European Union-7 (EU[7])-PIM, Screening Tool of Older person's Prescriptions/Screening tool to Alert to Right Treatment (STOPP/START), Fit fOR The Aged (FORTA), and PRISCUS list. Results: In total, 1472 patients were assessed in the geriatric oncology clinic, of which 823 (55.9%) were enrolled in the study. There were 1287 PIMs detected in 823 patients, of which 431 (33.5%) led to ADEs and 856 (66.5%) did not. Proton pump inhibitors and tramadol were the most common PIMs identified. ADEs were noted in 54 (14.7%) patients on proton pump inhibitors and in 145 (61.1%) patients on tramadol. ADEs were significantly associated with malnutrition, lower cognition, and frailty. The median MNA score in patients without and with ADEs was 20.5 (interquartile range [IQR], 17.5-24.0) and 19.5 (IQR, 15.5–23.5), respectively; P, 0.001. The median MMSE score for the patients without and with ADEs was 28 (IQR, 26-29) and 27 (IQR: 25-29), respectively; P, 0.001. The median CFS scores for the patients without and with ADEs were 3 (IQR, 2-4) and 4 (IQR, 3-5), respectively; P < 0.001. The median OS in patients without and with ADEs was 13.1 months (95% confidence interval [CI], 10.64-17.87) and 10.2 months (95% CI, 8.80-12.85), respectively; P, 0.002. The optimal cut-off for polypharmacy leading to ADEs was 4.5 medications. Conclusions: There is a dire need to recognize and appropriately manage PIMs in older patients with cancer as PIM-related toxicities may negatively impact survival. Monitoring PIMs and following the recommendations to optimize the dose, avoid the drug, and find alternatives may improve the oncologic outcomes. Future studies should focus on adding a control group of patients not on PIMs, following up on PIM after recommendations, and investigating the impact of these recommendations on oncologic outcomes (Clinical Trials Registry-India: CTRI/2020/04/024675).

Background: The geriatric assessment is a multidimensional evaluation of an older person. Globally, it is reported that geriatric assessments can lead to a change in the oncologic therapy decisions in approximately 28% of patients, but there are no Indian data regarding this. Objectives: We aimed to assess the proportion of patients in whom there was a change in the planned cancer-directed therapy following evaluation in the geriatric oncology clinic. Furthermore, we studied the proportion of patients who were recommended interventions for non-oncologic vulnerabilities and the factors associated with the change in the cancer-directed treatment plan following the geriatric assessment. Materials and Methods: This was an observational study conducted in the Department of Medical Oncology at the Tata Memorial Hospital, Mumbai, India. Patients aged 60 years and over with a diagnosis of malignancy were evaluated in the geriatric oncology clinic. The results of the geriatric assessment were entered in the electronic medical records (EMR). The systemic therapy plan before the geriatric assessment and the final therapy plan were retrospectively captured from the EMR. Any change in the systemic therapy plan following the geriatric assessment was recorded. Results: We enrolled 617 patients in the study between June 2018 and September 2021. The median age was 69 years (range, 60–100); 470 (76.2%) were men. The common malignancies were lung cancer in 243 (39.4%) and gastrointestinal in 208 (33.7%). The intent of therapy was palliative in 339 (54.9%) patients. There were 498 (80.7%) patients who were vulnerable or frail on the geriatric assessment. Following their geriatric assessment, systemic therapy plans were changed in 239 (38.7%) patients. The most common treatment change was deintensification in 198 patients (32.1%), comprising dose reduction in 83 (13.4%), a decrease in the number of chemotherapy medicines in 23 (3.7%), the substitution of chemotherapy by targeted therapy (4, 0.6%), oral hormonal therapy (4, 0.6%), oral tyrosine kinase inhibitor (16, 2.6%), immunotherapy (7, 1.1%), and withholding systemic therapy in 55 (8.9%) patients. Withholding systemic therapy included a change from chemoradiotherapy to radical radiation alone in 26 (4.2%), withholding neoadjuvant or adjuvant chemotherapy in 8 (1.3%), and a change to best supportive care in 21 (3.4%). Conclusions: The results of the geriatric assessment led to a change in the systemic therapy plan in almost 40% of older Indian patients with cancer. The geriatric assessment adds valuable information to the oncologic decision-making process for older persons with cancer. (Clinical Trials Registry-India: CTRI/2020/04/024675).