Decision Trees in Hematological Malignancies: Study Identifies Key Triggers

Older age is a risk factor for hematologic malignancies. It also complicates the management of hematologic malignancies because of the comorbidities, polypharmacy, poor adherence, and mortality associated with older age.¹

Medication reconciliation and pharmacist counseling are crucial to clinical management, but these activities are time-consuming and require teams to optimize resources.¹ Medical teams need to identify the patients at the highest risk of medication errors to prioritize the management of these patients.

The objective of a study published in the Journal of Oncology Pharmacy Practice was to build a decision tree to optimize pharmaceutical consultation for older patients with hematologic malignancies.¹ The study included patients at the hospital of Limoges between January 2017 and August 2018. Patients were 75 years of age and older, were treated in the hematology and cell therapy outpatient department, and had a hematologic malignancy treated with chemotherapy.

Researchers followed patients for 3 consultations, the first at inclusion, the second at 1 month, and the third at 3 months. The study assessed sociodemographic characteristics, frailty status, potentially inappropriate medications, cholinergic medications, self-medication, the complexity of prescriptions, polypharmacy, and renal function.¹

Researchers identified pharmaceutical interventions (PIs) in 87.3% of patients, the most common of which was non-compliance with national recommendations. Patients with potentially inappropriate medications were significantly associated with female gender, polypharmacy, and the presence of an anticholinergic drug. Frailty was a protective factor for being prescribed an anticholinergic medication.¹

Based on the results, researchers created a decision tree, which serves as a guide for the team in prioritizing patients for consultations. A specialized nurse completes a frailty screening and target drug screening for all patients on chemotherapy.

A pharmacist will counsel fit patients taking 10 or more prescriptions. Frail patients receive pharmacist consultation if they take 5 or more medications or targeted drugs. Follow-up consultation occurs at 1 month and then every 3 months for all patients with at least 1 pharmaceutical intervention.

Researchers developed the decision tree to optimize therapeutic management while also improving the use of available pharmaceutical resources. The multidisciplinary strategy aims to improve quality and safety for older patients with hematologic malignancies.

About the Author

Lindsey Sawtelle is a 2022 PharmD candidate at the University of Connecticut.

Reference

Strumia M, Fargeas JB, Marcellaud E, et al. Development of a decision tree for the pharmacy-led consultation of elderly patients with haematological malignancies [published online ahead of print, 2022 Feb 28]. J Oncol Pharm Pract. 2022;10781552221080419. doi:10.1177/1078155222108041