Review of Potentially Inappropriate Medication Assessment Tools in Elderly Patients with Advanced Cancer Palliative Care
Keywords:
elderly adults, palliative care, potentially inappropriate medications, deprescribing, clinical pharmacyAbstract
Elderly patients with advanced cancer receiving palliative care often experience multiple comorbidities and polypharmacy, which place them at high risk of potentially inappropriate medication use and drug-related problems. This narrative review was conducted through a literature search of major medical databases, including PubMed, Scopus, and Web of Science, covering publications from January 1, 2018, to December 31, 2025. Studies related to the assessment of potentially inappropriate medications in elderly patients with advanced cancer receiving palliative care were included.
The objective of this review was to summarize the tools used to assess potentially inappropriate medication use in this population. The review covers general geriatric assessment tools, including the Beers Criteria, the STOPP/START criteria, and the Medication Appropriateness Index, as well as tools specifically designed for patients at the end of life, such as STOPPFrail and OncPal.
Evidence from clinical studies indicates that general geriatric tools have limitations when applied in palliative care settings, as they may not adequately reflect treatment goals focused on symptom relief and quality of life. In contrast, palliative-specific tools can better support deprescribing decisions, reduce medication burden, and lower healthcare costs without adversely affecting clinical outcomes. The selection and application of assessment tools should be tailored to the individual patient context, estimated life expectancy, and goals of care.
Clinical pharmacists play a crucial role in conducting comprehensive medication reviews, applying validated assessment tools in conjunction with clinical judgment, and promoting shared decision-making with multidisciplinary teams, patients, and caregivers to enhance medication appropriateness, improve safety, and support quality of life in contemporary palliative cancer care.
References
Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10–45. doi: 10.3322/caac.21871.
World Health Organization. Global cancer burden growing, amidst mounting need for services [Internet]. Geneva: World Health Organization; 2024 [cited 2025 Dec 12]. Available from: https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services
Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. CA Cancer J Clin. 2016;66(4):337-50. doi: 10.3322/caac.21342.
Bittencourt NCCdM, Santos KA, Mesquita MGdR, Silva VGd, Telles AC, Silva MMd. Signs and symptoms manifested by patients in palliative cancer care in homecare: integrative review. Esc Anna Nery. 2021;25(4):e20200520. doi: 10.1590/2177-9465-EAN-2020-0520.
World Health Organization. Palliative care [Internet]. Geneva: World Health Organization; 2020 [cited 2025 Dec 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
McNeil MJ, Kamal AH, Kutner JS, Ritchie CS, Abernethy AP. The burden of polypharmacy in patients near the end of life. J Pain Symptom Manage. 2016;51(2):178-83.e2. doi: 10.1016/j.jpainsymman.2015.09.003.
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6-14. doi: 10.1046/j.1365-2125.2003.02007.x.
Shi S, Mörike K, Klotz U. The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol. 2008;64(2):183-99. doi: 10.1007/s00228-007-0422-1.
Thompson W, McDonald EG. Polypharmacy and deprescribing in older adults. Annu Rev Med. 2024;75(1):113-27. doi: 10.1146/annurev-med-070822-101947.
Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100(1):32-8. PMID: 31259501.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi: 10.1186/s12877-017-0621-2.
Sehgal A, Noronha V, Ramaswamy A, Kumar A, Pillai A, Rao A, et al. Potentially inappropriate medications, their adverse events, and impact on geriatric vulnerabilities, frailty, and survival in older Indian patients with cancer: a retrospective observational study. Canncer Res Stat Treat. 2024;7(1):45-54. doi: 10.4103/crst.crst_414_23.
Mohamed MR, Ramsdale E, Loh KP, Arastu A, Xu H, Obrecht S, et al. Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis. Oncologist. 2020;25(1):e94-108. doi: 10.1634/theoncologist.2019-0406.
Bandidwattanawong C, Rattanaserikulchai P, Jetsadavanit N. Polypharmacy and potentially-inappropriate medications are prevalent in the elderly cancer patients receiving systemic cancer therapy and they co-relate with adverse outcomes. BMC Geriatr. 2023;23(1):775. doi: 10.1186/s12877-023-04471-3.
Oliveira RF, Oliveira AI, Cruz AS, Ribeiro O, Afreixo V, Pimentel F. Polypharmacy and drug interactions in older patients with cancer receiving chemotherapy: associated factors. BMC Geriatr. 2024;24(1):557. doi: 10.1186/s12877-024-05135-6.
Ramsdale E, Mohamed M, Yu V, Otto E, Juba K, Awad H, et al. Polypharmacy, potentially inappropriate medications, and drug-drug interactions in vulnerable older adults with advanced cancer initiating cancer treatment. Oncologist. 2022;27(7):e580-8. doi: 10.1093/oncolo /oyac053.
Al-Azayzih A, Ahmad EB, Jarab A, Kharaba Z, Al-Kubaisi KA. Inappropriate medications use among elderly cancer patients according to Beer’s criteria. Pharm Prac. 2024;22(1):1-6. doi: 10.18549/PharmPract.2024.1.2920.
Mohamed MR, Mohile SG, Juba KM, Awad H, Wells M, Loh KP, et al. Association of polypharmacy and potential drug-drug interactions with adverse treatment outcomes in older adults with advanced cancer. Cancer. 2023;129(7):1096-104. doi: 10.1002/cncr.34642.
Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM. Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol. 2016;7(5):346-53. doi: 10.1016/j.jgo.2016.07.010.
Khaledi AR, Kazemi M, Tahmasebi M. Frequency of polypharmacy in advanced cancer patients consulted with the palliative service of Imam Khomeini Hospital (Tehran) Iran, 2017. Asian Pac J Cancer Prev. 2019;20(1):131-4. doi: 10.31557/APJCP.2019.20.1.131.
McDermott CL, Curtis JR, Sun Q, Fedorenko C, Kreizenbeck K, Ramsey SD. Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract. 2022;28(4):836-41. doi: 10.1177/10781552211006180.
Kirci O, Cubukcu M, Bahsi R, Yurt NS, Kirci K. Examining potentially inappropriate medication use among elderly individuals in palliative care: a comprehensive study. Heliyon. 2024;10(10):e30635. doi: 10.1016/j.heliyon.2024.e30635.
Schenker Y, Park SY, Jeong K, Pruskowski J, Kavalieratos D, Resick J, et al. Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. J Gen Intern Med. 2019;34(4):559-66. doi: 10.1007/s11606-019-04837-7.
Murphy M, Bennett K, Wright M, O'Reilly M, Conroy M, Hughes C, et al. Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study. Int J Clin Pharm. 2023;45(1):174-83. doi: 10.1007/s11096-022-01506-4.
Hedman C, Frisk G, Björkhem-Bergman L. Deprescribing in palliative cancer care. Life (Basel). 2022;12(5):613. doi: 10.3390/life12050613.
Morin L, Vetrano DL, Rizzuto D, Calderón-Larrañaga A, Fastbom J, Johnell K. Choosing wisely? Measuring the burden of medications in older adults near the end of life: nationwide, longitudinal cohort study. Am J Med. 2017;130(8):927-36.e9. doi: 10.1016/j.amjmed.2017.02.028.
Pasierski T. Modification of cardiovascular pharmacotherapy in palliative care patients with cancer: a narrative review. Pol Arch Intern Med. 2017;127(10):687-93. doi: 10.20452/pamw.4098.
McKearney K, Coleman JJ. Prescribing medicines for elderly patients. Medicine. 2020;48(7):463-7. doi: 10.1016/j.mpmed.2020.04.004.
Tian F, Zhao M, Chen Z, Yang R. Prescription of potentially inappropriate medication use in older cancer outpatients with multimorbidity: concordance among the Chinese, AGS/Beers, and STOPP criteria. Front Pharmacol. 2022;13:857811. doi: 10.3389/fphar.2022.857811.
Feng X, Higa GM, Safarudin F, Sambamoorthi U, Chang J. Prevalence and factors associated with potentially inappropriate medication use in older medicare beneficiaries with cancer. Res Social Adm Pharm. 2020;16(10):1459-71. doi: 10.1016/j.sapharm.2019.12.018.
van Loveren FMAM, van Berlo-van de Laar IRF, Imholz ALT, van 't Riet E, Taxis K, Jansman FGA. Prevalence and follow-up of potentially inappropriate medication and potentially omitted medication in older patients with cancer - the PIM POM study. J Geriatr Oncol. 2021;12(1):80-4. doi: 10.1016/j.jgo.2020.06.014.
van Merendonk LN, Peters BJM, Möhlmann JE, Hunting CB, Kastelijn EA, van den Broek MPH. The potential for deprescribing in a palliative oncology patient population: a cross-sectional study. Eur J Hosp Pharm. 2023;31(1):10-5. doi: 10.1136/ejhpharm-2021-003143.
Gradalski T. Polypharmacy and medication errors on admission to palliative care. Pol Arch Intern Med. 2019;129(10):659-66. doi: 10.20452/pamw.14969.
The 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-81. doi: 10.1111/jgs.18372.
O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart J-B, Onder G, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625-32. doi: 10.1007/s41999-023-00777-y.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-51. doi: 10.3238/arztebl.2010.0543.
Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-75. doi: 10.1007/s00228-015-1860-9.
Wehling M, Pazan F, Weiß C. Forta – Fit for the Aged [Internet]. Mannheim (DE): Universitätsmedizin Mannheim, University of Heidelberg; 2024 [cited 2025 Dec 12]. Available from: https://www.umm.uni-heidelberg.de/experimentelle-pharmakologie/research/group-wehling/
Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045-51. doi: 10.1016/0895-4356(92)90144-c.
ชนัตถา พลอยเลื่อมแสง, กรรณิกา เทียรฆนิธิกูล, จันทร์จิรา ชอบประดิถ, สุรศักดิ์ สุนทร, วิมล สุวรรณเกษาวงศ์. การพัฒนารายการยาเพื่อใช้คัดกรองและลดโอกาสเกิดปัญหาจากการใช้ยาในผู้สูงอายุ [อินเทอร์เน็ต]. นนทบุรี: สถาบันวิจัยระบบสาธารณสุข (สวรส.); 2556 [สืบค้นเมื่อ 13 ธ.ค. 2568]. สืบค้นจาก: https://kb.hsri.or.th/dspace/handle/11228/4244
Al-Azayzih A, Bani-Ahmad E, Jarab AS, Kharaba Z, Al-Kubaisi K. Prevalence and associated predictors of inappropriate and omitted medications prescribing in older patients with advanced cancer: a cross-sectional study. Clin Interv Aging. 2023;18:1653-61. doi: 10.2147/CIA.S430208.
Hong S, Lee JH, Chun EK, Kim KI, Kim JW, Kim SH, et al. Polypharmacy, inappropriate medication use, and drug interactions in older Korean patients with cancer receiving first-line palliative chemotherapy. Oncologist. 2020;25(3):e502-11. doi: 10.1634/theoncologist.2019-0085.
Prasert V, Akazawa M, Shono A, Chanjaruporn F, Ploylearmsang C, Muangyim K, et al. Applying the lists of risk drugs for Thai elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use. Res Social Adm Pharm. 2018;14(5):451-8. doi: 10.1016/j.sapharm.2017.05.012.
Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care. Eur J Clin Pharmacol. 2024;80(4):603-12. doi: 10.1007/s00228-024-03633-5.
Whitman A, DeGregory K, Morris A, Mohile S, Ramsdale E. Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study. Support Care Cancer. 2018;26(12):4105-13. doi: 10.1007/s00520-018-4281-3.
Keche YN, Gaikwad NR, Wasnik PN, Siddiqui S, Nagpure K, Dhaneria S. Usefulness of STOPP/START criteria and Beers criteria for prescribing in geriatric patients in a tertiary health care center, Raipur, Central India. J Family Med Prim Care. 2022;11(11):7064-71. doi: 10.4103/jfmpc.jfmpc_733_22.
Tang J, Wang K, Yang K, Jiang D, Fang X, Su S, et al. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study. BMC Geriatr. 2023;23(1):44. doi: 10.1186/s12877-023-03743-2.
Takahashi M, Matsui M, Inoue R, Uchino N. Potentially inappropriate medication discontinued or changed based on pharmacists' recommendations in older end-stage cancer patients receiving palliative care: a cross-sectional study. Ann Palliat Med. 2021;10(11):11301-7. doi: 10.21037/apm-21-1788.
Curtin D, Gallagher P, O'Mahony D. Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2. Age Ageing. 2021;50(2):465–71. doi: 10.1093/ageing/afaa159.
Lindsay J, Dooley M, Martin J, Fay M, Kearney A, Khatun M, et al. The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline’. Support Care Cancer. 2015;23(1):71–8. doi: 10.1007/s00520-014-2322-0.
Chae HW, Kim Y, Suh Y, Lee J, Lee E, Lee E, et al. Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study. BMC Geriatr. 2022;22(1):367. doi: 10.1186/s12877-022-03067-7.
Hurley E, Dalton K, Byrne S, Foley T, Walsh E. Pharmacist-led deprescribing using STOPPFrail for frail older adults in nursing homes. J Am Med Dir Assoc. 2024;25(9):105122. doi: 10.1016/j.jamda.2024.105122.
Curtin D, Jennings E, Daunt R, Curtin S, Randles M, Gallagher P, et al. Deprescribing in older people approaching end of life: a randomized controlled trial using STOPPFrail criteria. J Am Geriatr Soc. 2020;68(4):762-9. doi: 10.1111/jgs.16278.
Prabhu A, Sutherland A, Bradley V, Pegrum H. P-99 the use of an oncological palliative deprescribing guideline to aid rationalising medications in patients in the last six months of life. BMJ Support Palliat Care. 2017;7(Suppl 1):A36.3-A37. doi: 10.1136/bmjspcare-2017-00133.98.
McAdam C, O'Dwyer E, Dalton K. Pharmacist-led deprescribing interventions for cancer patients in a specialist palliative care setting. Support Care Cancer. 2025;33(4):321. doi: 10.1007/s00520-025-09341-9.
Lee J, Lee CW, Kim HS, Kim HR, Lim SY, Kim JR. Potentially inappropriate prescriptions in end-of-life cancer patients in home-based hospice care. J Pain Symptom Manage. 2025;70(1):22-9. doi: 10.1016/j.jpainsymman.2025.03.021.
Yoodee J, Rodsawai P, Fukhammee P, Suriyong P, Penthinapong T. Polypharmacy and inappropriate medication use in terminal cancer patients: a retrospective study from a community hospital in Thailand. Pharm Sci Asia. 2025;52(4):584-91. doi: 10.29090/psa.2025.04.25.4875.
Heinrich CH, McCarthy S, McHugh S, Donovan MD. Identification of potentially inappropriate medications in frail older adults residing in long-term care: a retrospective chart review study. Drugs Real World Outcomes. 2023;10(1):97-106. doi: 10.1007/s40801-022-00342-2.
Lavan AH, O’Mahony D, Gallagher P. STOPPFrail (screening tool of older persons’ prescriptions in frail adults with a limited life expectancy) criteria: application to a representative population awaiting long-term nursing care. Eur J Clin Pharmacol. 2019;75(5):723-31. doi: 10.1007/s00228-019-02630-3.
de Andrade FK, Nunes RPI, Zanetti MOB, Zanetti ACB, Dos Santos M, de Oliveira AM, et al. Validated medication deprescribing instruments for patients with palliative care needs: a systematic review. Farm Hosp. 2024;48(2):83–9. doi: 10.1016/j.farma.2023.08.004.
Lunghi C, Domenicali M, Vertullo S, Raschi E, De Ponti F, Onder G, et al. Adopting STOPP/START criteria version 3 in clinical practice: a Q&A guide for healthcare professionals. Drug Saf. 2024;47(11):1061–74. doi: 10.1007/s40264-024-01453-1.
Dalleur O, Sibille FX, Mouzon A, Vaillant F, Marien S, Spinewine A, et al. Improving usability of the STOPP/START version 3 criteria: development of a practice tool for clinicians, students and researchers. Eur Geriatr Med. 2025;16(4):1403–13. doi: 10.1007/s41999-025-01214-y.
Awad A, Hanna O. Potentially inappropriate medication use among geriatric patients in primary care setting: a cross-sectional study using the Beers, STOPP, FORTA and MAI criteria. PLoS One. 2019;14(6):e0218174. doi: 10.1371/journal.pone.0218174.
McNeill R, Hanger HC, Chieng J, Chin P. Polypharmacy in palliative care: two deprescribing tools compared with a clinical review. J Palliat Med. 2021;24(5):661–7. doi: 10.1089/jpm.2020.0225.
Vatcharavongvan P, Prasert V, Ploylearmsang C, Puttawanchai V. Potentially inappropriate medication use among geriatric patients in primary health care centers by applying the list of risk drugs for Thai elderly criteria. J Public Hlth Dev [internet]. 2021 [cited 2025 Dec 13];19(3):58-70. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/251862
Jenghua K, Sangtong H, Jaiya N, Jaroenteerawit W, Khiewpradang A. The use of potentially inappropriate medications (PIMs) from Thailand criteria among urban community-dwelling elderly: prevalence, PIMs, and factors associated. Thai Bull Pharm Sci. 2018;14(1):49–63. doi: 10.69598/tbps.14.1.49-63.
Vatcharavongvan P, Prasert V, Ploylearmsang C, Puttawanchai V. Prevalence and factors that influence potentially inappropriate medication use among Thai elderly in primary care settings. Can Geriatr J. 2021;24(4):332-40. doi: 10.5770/cgj.24.516.
Kutner JS, Blatchford PJ, Taylor DH Jr, Ritchie CS, Bull JH, Fairclough DL, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi: 10.1001/jamainternmed.2015.0289.
Kim S, Park S, Yoo SH, Choi KH, Lee JY. Potentially inappropriate medication use based on two deprescribing criteria and related factors in patients with terminal cancer: a cross-sectional study. J Geriatr Oncol. 2023;14(3):101472. doi: 10.1016/j.jgo.2023.101472.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Health Administration Division, Office of the Permanent Secretary, Ministry of Public Health and The Society of Hospital Pharmacist, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ข้อความภายในบทความที่ตีพิมพ์ในวารสารเภสัชกรรมคลินิกทั้งหมด รวมถึงรูปภาพประกอบ ตาราง เป็นลิขสิทธิ์ของกองบริหารการสาธารณสุข สำนักงานปลัดกระทรวงสาธารณสุข และ ชมรมเภสัชกรโรงพยาบาลกระทรวงสาธารณสุข การนำเนื้อหา ข้อความหรือข้อคิดเห็น รูปภาพ ตาราง ของบทความไปจัดพิมพ์เผยแพร่ในรูปแบบต่าง ๆ เพื่อใช้ประโยชน์ในเชิงพาณิชย์ ต้องได้รับอนุญาตจากกองบรรณาธิการวารสารเภสัชกรรมคลินิกอย่างเป็นลายลักษณ์อักษร
กองบริหารการสาธารณสุข สำนักงานปลัดกระทรวงสาธารณสุข และ ชมรมเภสัชกรโรงพยาบาลกระทรวงสาธารณสุข อนุญาตให้สามารถนำไฟล์บทความไปใช้ประโยชน์และเผยแพร่ต่อได้ โดยอยู่ภายใต้เงื่อนไขสัญญาอนุญาตครีเอทีฟคอมมอน (Creative Commons License: CC) โดย ต้องแสดงที่มาจากวารสาร – ไม่ใช้เพื่อการค้า – ห้ามแก้ไขดัดแปลง, Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
ข้อความที่ปรากฏในบทความในวารสารเป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับกองบริหารการสาธารณสุข สำนักงานปลัดกระทรวงสาธารณสุข และ ชมรมเภสัชกรโรงพยาบาลกระทรวงสาธารณสุข และบุคลากรในกองฯ หรือ ชมรมฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเอง ตลอดจนความรับผิดชอบด้านเนื้อหาและการตรวจร่างบทความเป็นของผู้เขียน ไม่เกี่ยวข้องกับกองบรรณาธิการ
