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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).

Abstract Background Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. Methods A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's‐2015, STOPP/START criteria v2, PRISCUS‐2010, Fit fOR The Aged (FORTA)‐2018, and the EU(7)‐PIM list‐2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland–Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. Results Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)‐PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of −0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were −0.039 (−0.053 to −0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and −0.148 (−0.165 to −0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33–1.63), p =

Background: Frailty is a significant concern in older patients with cancer, yet there are limited data on frailty and its associated risk factors, particularly in Indian patients. Objectives: The primary objective was to evaluate the occurrence of frailty among older Indian patients with cancer. The secondary objective was to identify the factors associated with frailty. Materials and Methods: This cross-sectional study was conducted in the geriatric oncology clinic of the Department of Medical Oncology at the Tata Memorial Hospital, Mumbai, India. We included all patients evaluated between February 2020 and June 2023. Frailty was defined using the clinical frailty scale (CFS) score ≥4. The bivariate association between frailty and other factors was assessed by the Chi-square test and multivariate logistic regression. Results: We included 2214 patients, with a median age of 67 (interquartile range [IQR], 64–72) years, and 1708 (77.2%) were male. The most common cancer sites were gastrointestinal (815 [37.1%]) and lung (786 [35.8%]). We found that 1324 (59.8%) patients were frail. Frailty was positively associated with age (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.15-2.29), Eastern Cooperative Oncology Group performance status (ECOG PS) (PS 1: aOR, 4.75; 95% CI, 1.45-15.59; PS 2: aOR: 10.11; 95% CI, 2.98-34.25; PS 3: aOR, 10.97; 95% CI 2.49-48.23), tumor metastasis (aOR, 1.62; 95% CI, 1.26-2.09), impaired basic activities of daily living (aOR, 1.84; 95% CI, 1.20-2.83), impaired instrumental activities of daily living (aOR, 4.21; 95% CI, 2.94-6.02), higher timed-up-and-go score (aOR, 3.26; 95% CI, 2.54-4.18), at risk for malnutrition (aOR, 2.05; 95% CI, 1.52-2.75), malnutrition (aOR, 2.33; 95% CI, 1.50-3.61), depression (aOR, 2.22; 95% CI, 1.66-2.96), and hypoalbuminemia (aOR, 0.59; 95% CI, 0.45-0.79). Conclusion: Frailty is prevalent among older Indian patients with cancer. CFS may be considered a rapid screening tool to help identify vulnerable patients in need of a geriatric assessment (GA). These findings emphasize the need for a multidisciplinary GA and targeted interventions to address frailty and improve outcomes in this vulnerable population. (Clinical Trials Registry-India: CTRI/2020/04/024675).

Background: Older patients with cancer are at a higher risk of invasive infections. Vaccination is an effective approach to decrease the mortality and morbidity associated with infections. Objectives: Our primary objective was to evaluate the proportion of older patients with cancer who had received routine vaccinations against pneumococcal, influenza, and coronavirus disease 2019 (COVID-19). Our secondary objective was to identify the factors associated with vaccine uptake such as age, sex, education, marital status, comorbidities, and place of residence. Materials and Methods: This cross-sectional observational study was conducted in the geriatric oncology outpatient clinic of the Department of Medical Oncology at the Tata Memorial Hospital, a tertiary care cancer hospital in Mumbai, India, from February 2020 to January 2023. We included all patients aged ≥60 years who were evaluated in the geriatric oncology clinic during the study period and for whom the immunization details were available. The uptake of COVID-19 vaccine was calculated from March 2021 onwards, which was when the COVID-19 vaccine became available to patients aged ≥60 years in India. Results: We enrolled 1762 patients; 1342 (76.2%) were male. The mean age was 68.4 (SD, 5.8) years; 795 (45%) patients were from the west zone of India. Only 12 (0.68%) patients had received the pneumococcal vaccine, and 13 (0.7%) had received the influenza vaccine. At least one dose of the COVID-19 vaccine had been taken by 1302 of 1562 patients (83.3%). On univariate logistic regression, education, marital status, geographic zone of residence, and primary tumor site were correlated with the uptake of COVID-19 vaccine. Factors associated with a greater COVID-19 vaccine uptake included education (up to Std 10 and higher vs. less than Std 10: Odds Ratio [OR], 1.46; 95% confidence interval [CI], 1.07-1.99; P = 0.018, and illiterate vs. less than Std 10: OR, 0.70; 95% CI, 0.50-0.99; P = 0.041), marital status (unmarried vs. married: OR, 0.27; 95% CI, 0.08-1.08; P = 0.046, and widow/widower vs. married: OR, 0.67; 95% CI, 0.48-0.94; P = 0.017), lung and gastrointestinal vs. head-and-neck primary tumors (lung cancer vs. head-and-neck cancer: OR, 1.60; 95% CI, 1.02–2.47; P = 0.038, and gastrointestinal vs .head-and-neck cancer: OR, 2.18; 95% CI, 1.37-3.42; P < 0.001), and place of residence (west zone vs. central India: OR, 0.34; 95% CI, 0.13-0.75; P = 0.015). Conclusion: Fewer than 1 in 100 older Indian patients with cancer receive routine immunization with influenza and pneumococcal vaccines. Hearteningly, the uptake of COVID-19 vaccination in older Indian patients with cancer is over 80%, possibly due to the global recognition of its importance during the pandemic. Similar measures as those used to increase the uptake of COVID-19 vaccines during the pandemic may be beneficial to increase the uptake of routine vaccinations (Clinical Trials Registry, India: CTRI/2020/04/024675).

A 62-year-old woman with no comorbidity presented with dyspnea since 2 months and fatigue since 1 month. She was having severe anemia with hepatosplenomegaly and icterus. Anemia due to blood loss was ruled out. With a history of blood transfusions and episodes of jaundice in the past, evaluation of hemolytic anemia was carried out. Her serum iron level was normal. Serum lactate dehydrogenase level was raised, and extracorpuscular causes were absent. Hemoglobin electrophoresis was performed in view of suspected hemoglobinopathy. It showed hemoglobin-D Punjab homozygous type, which is very rare. Its presentation in older age is even rarer to warrant this report.