Role of Clinical Pharmacists in Deprescribing Potentially Inappropriate Medications and Managing Polypharmacy among Cancer Patients Receiving Palliative Care: A Narrative Review
Authors: Keerthana Koliyate, Jayakrishnan Sada Sivan, Fasmiya Thabassum, Najiya Mahamood, Amiya Narangoli Thazhe
Indian Journal of Pharmacy Practice, Vol. 20, Issue 1, pp. 7-15, (2027)
Abstract
Polypharmacy and the use of potentially inappropriate medications (PIMs) are highly prevalent among patients with advanced cancer receiving palliative care. As the disease progresses and treatment goals shift from disease modification to symptom control and quality of life, many preventive and long-term medications may no longer provide meaningful clinical benefit. Continued use of these medications contributes to medication burden, adverse drug reactions, drug-drug interactions, reduced adherence and increased healthcare costs. Deprescribing, defined as the planned and supervised withdrawal or dose reduction of medications that are no longer beneficial or may cause harm, has emerged as an important strategy for optimizing medication use in this population. The review was conducted by searching PubMed, Scopus, Web of Science, ScienceDirect and Google Scholar for articles published between January 2014 and March 2025 and 22 eligible studies, including original research articles and systematic reviews were included. This narrative review summarizes the current evidence on the role of clinical pharmacists in identifying and deprescribing potentially inappropriate medications and managing polypharmacy among cancer patients receiving palliative care. A comprehensive literature review was conducted using studies evaluating pharmacist-led deprescribing interventions, medication appropriateness assessments, palliative care deprescribing tools and clinical outcomes associated with deprescribing in oncology and palliative care settings. The available evidence demonstrates that clinical pharmacists play a pivotal role in medication reconciliation, identification of potentially inappropriate medications, implementation of evidence-based deprescribing strategies, patient and caregiver education, and interdisciplinary collaboration. Pharmacist-led interventions, guided by tools such as the Oncological Palliative Care Deprescribing Guideline (OncPal), the Screening Tool of Older Persons' Prescriptions in Frail Adults with Limited Life Expectancy (STOPPFrail) and the Potentially Inappropriate Prescribing in Older Adults with Cancer Receiving Palliative Care (PIP-CPC) criteria, have consistently been associated with high physician acceptance rates, reduced medication burden, improved medication appropriateness, decreased healthcare expenditure and enhanced patient-centred care. Clinical pharmacists are therefore integral members of the palliative care team and significantly contribute to safe and effective deprescribing practices, facilitating medication optimization, minimizing polypharmacy-related harms and improving the quality of care for patients with advanced cancer. Further multicentre studies are warranted to establish standardized deprescribing models and evaluate long-term patient outcomes.
Keywords: Cancer, Clinical Pharmacist, Deprescribing, Oncology, Palliative Care, Polypharmacy, Potentially Inappropriate Medications
