Cancer Clinical Trial
Official title:
Decreasing Polypharmacy in Older Adults With Curable Cancers: a Pilot Cluster-randomized Trial
This is a single-site cluster-randomized trial to assess efficacy and implementation outcomes of deprescribing interventions in 72 older adults with polypharmacy (PP) and curable cancers initiating chemotherapy. Oncologists (as the cluster) will enroll 6 patients each and will be randomized to either a pharmacist-led deprescribing intervention or patient education intervention. Initial focus groups with oncologists, nurses, pharmacists, primary care physicians, and patients will provide data for initial adaptations to the pharmacist-led intervention arm, and 8 patients will be enrolled as a pre-trial cohort to further refine and adapt the pharmacist-led intervention.
Status | Recruiting |
Enrollment | 80 |
Est. completion date | March 31, 2025 |
Est. primary completion date | March 31, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 65 Years and older |
Eligibility | Inclusion Criteria: - Be age =65 years; - Have a diagnosis of malignancy including aggressive lymphoma or cancers of the breast, gastrointestinal system, genitourinary system, or lung; - Be initiating chemotherapy, alone or in combination with other systemic antineoplastic agents, (for a period of at least 3 months) within 4 weeks of enrollment; - Screen positive for polypharmacy (>10 medications) or potentially inappropriate medications - Be able to read and write English; - Be able to give informed consent, as determined by the primary oncologist, or has a legally authorized representative to sign consent in the case of cognitive impairment. Exclusion Criteria: - Be planned to receive a cancer treatment regimen that does not include standard cytotoxic chemotherapy (e.g., only targeted therapies, hormonal therapies, monoclonal antibody therapies, immunotherapy, etc.), - Have surgery or radiation without concurrent chemotherapy planned within 3 months of consent, - Have a planned referral to the geriatric oncology clinic (SOCARE) within one month of treatment initiation, - Lack decisional capacity, if a legally authorized representative is not available to sign consent and participate in study visits and follow-up phone calls. |
Country | Name | City | State |
---|---|---|---|
United States | University of Rochester | Rochester | New York |
Lead Sponsor | Collaborator |
---|---|
University of Rochester | National Cancer Institute (NCI) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Change between arms in implementation | Barriers and facilitators of intervention (implementation outcome) | 2 years | |
Primary | Change between arms in Relative dose intensity (RDI) of chemotherapy | Relative dose intensity (RDI) of chemotherapy, based upon standard dosing from National Comprehensive Cancer Network guidelines or similar reference. RDI assesses the proportion of planned therapy that the patient receives within 12 weeks of initiation of chemotherapy. | 12 Weeks | |
Secondary | Change between arms in Changes in functional status | Changes in functional status, based on Instrumental Activities of Daily Living (IADL) | 12 Weeks | |
Secondary | Change between arms in Changes in functional status | Changes in functional status, based on Activities of Daily Living (ADL) | 12 Weeks | |
Secondary | Change between arms in Grade 3-5 chemotherapy toxicity | Grade 3-5 chemotherapy toxicity based on Common Terminology Criteria for Adverse Events (CTCAE) v.5 | 12 Weeks | |
Secondary | Hospitalizations | assessed as =1 or 0 | 12 Weeks | |
Secondary | Patient-reported falls | assessed as =1 or 0 | 12 Weeks | |
Secondary | Patient-reported symptoms | Patient-reported symptoms, assessed by selected elements of the NCI Patient Reported Outcomes CTCAE (PRO-CTCAE, 10-20 items). | 12 Weeks |
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