New research unveiled in the September 2025 issue of the Journal of the National Comprehensive Cancer Network (JNCCN) sheds transformative light on medication management in older adults with cancer. Leveraging a robust dataset from the Veterans Affairs (VA) Healthcare System in Boston, the study introduces and validates the Geriatric Oncology Potentially Inappropriate Medications scale, known as GO-PIMs. This precisely tailored tool is designed to discern medications that may inadvertently jeopardize the health of elderly cancer patients, signaling a pivotal step toward personalized, safer oncology care.
Older adults diagnosed with cancer confront a unique constellation of challenges: the coexistence of multiple chronic conditions, altered drug metabolism, and heightened vulnerability to treatment-related toxicity. The GO-PIMs scale, grounded in the NCCN Clinical Practice Guidelines in Oncology for Older Adult Oncology, targets this vulnerable demographic. Utilizing data from more than 380,000 older adults diagnosed between 2000 and 2022 with either solid tumors or hematologic malignancies, the study offers a sweeping view of medication-related risks that often remain obscured in the complexities of cancer care.
Central to the findings is the alarming prevalence of potentially inappropriate medications among older patients. Approximately 38% of the study cohort were prescribed at least one medication flagged by the GO-PIMs scale. Notably, selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for depression and anxiety, were the most frequently identified high-risk drugs. This revelation underscores the unintended consequences that stem from routine polypharmacy in cancer patients, challenging clinicians to rethink pharmacologic strategies in this sensitive group.
A critical revelation of the research is the stark association between GO-PIMs and frailty, a multifaceted syndrome characterized by diminished strength, endurance, and physiological reserve. The study found that each additional GO-PIM in a patient’s medication regimen corresponded with a 66% increase in the odds of being classified as mildly or moderately-to-severely frail at the time of cancer diagnosis. Frailty not only complicates cancer treatment but also predisposes patients to heightened morbidity and mortality, emphasizing the urgent need to reassess prescribing patterns.
Lead author Dr. Jennifer La, PhD, affiliated with Harvard Medical School and the VA Boston Cooperative Studies Program Center, articulates the paramount importance of these findings. “Our goal is to enhance the safety and tolerability of cancer treatments for older adults who are inherently fragile,” she explains. “By identifying medications that may contribute to adverse outcomes, GO-PIMs provides a clinical framework to reduce harm and optimize therapeutic regimens.”
Beyond frailty, the study highlights significant correlations between GO-PIMs use and increased rates of hospitalizations and mortality. These alarming links present compelling evidence that medication safety in geriatric oncology transcends mere symptom management; it is integral to survival and quality of life. The research calls for immediate integration of medication review protocols that move beyond drug counts to scrutinize the intrinsic risk profile of prescribed agents.
Senior author Clark DuMontier, MD, MPH, from Harvard Medical School and affiliated institutions including Brigham and Women’s Hospital and Dana-Farber Cancer Institute, emphasizes the transformative potential of incorporating GO-PIMs into electronic health records (EHRs). “Embedding this scale within EHR systems can proactively flag hazardous prescriptions, enabling clinicians to make informed decisions about deprescribing and alternative therapies,” he remarks. Dr. DuMontier shares that a pilot program utilizing GO-PIMs is underway in their local oncology clinic, aiming to demonstrate real-world benefits and scalability.
The timing of medication assessment emerges as an essential theme in this research. A cancer diagnosis serves as a critical juncture when older adults often begin systemic therapies involving complex and dynamic pharmacologic regimens. Frequent clinical interactions during treatment afford opportunities to revisit medication lists comprehensively, tailoring care plans to evolving patient needs. The GO-PIMs scale offers an evidence-based lens through which to examine this intricate interplay, fostering safer, more individualized oncology care pathways.
Commenting independently on the study, Dr. Mostafa Mohamed, MBBCh, PhD, from the University of Rochester Medical Center, underscores the novelty and clinical relevance of the GO-PIMs framework. He notes, “This tool represents a significant advance by providing a cancer-specific approach to identifying potentially inappropriate medications in older adults, utilizing national data to validate its impact.” Dr. Mohamed advocates for widespread adoption of such tools to mitigate the often-overlooked risks of polypharmacy in oncology.
He further asserts that the future of geriatric oncology hinges on integrating tools like GO-PIMs into everyday clinical workflows—not merely to highlight at-risk medications, but to enable clinicians to make actionable adjustments. “Medication safety should be a dynamic conversation, continually updated in response to the patient’s clinical trajectory and treatment goals,” he concludes.
The broader clinical implications of the GO-PIMs validation are profound. Traditionally, geriatric oncology has grappled with balancing efficacious cancer treatment against the risks imposed by comorbidities and polypharmacy. By operationalizing potentially inappropriate medication identification with a standardized scale linked to clinical frailty and outcomes, this research charts a promising path toward precision medicine that respects the nuanced needs of older adults.
Moreover, GO-PIMs complements existing frailty assessment methods, enriching the multidimensional evaluation necessary to optimize therapeutic decisions. The intersection of medication safety, frailty, and oncologic outcomes revealed by this study offers oncologists, pharmacists, and care teams a powerful tool to align treatment complexity with patient resilience, strengthening the foundation for personalized care strategies.
The findings also resonate with ongoing efforts by the National Comprehensive Cancer Network (NCCN) to enhance evidence-based guidelines tailored to older adults. The GO-PIMs scale, derived from meticulous guideline development and validated through expansive real-world datasets, exemplifies the kind of innovation needed to meet the challenges of an aging cancer population.
This study, along with corresponding commentary featured in the September 2025 issue of JNCCN, represents a milestone in oncology research and patient safety. As the rate of cancer diagnoses in older adults continues to rise, tools like GO-PIMs are poised to play a critical role in shaping safer, more effective cancer care across healthcare systems nationally and potentially globally.
As an added milestone, the journal’s rising Impact Factor, now at 16.4, reflects its growing influence in shaping oncology practice and research innovation. This ascendancy underscores JNCCN’s commitment to disseminating pivotal knowledge that alters clinical paradigms and enhances patient outcomes across the cancer care continuum.
Subject of Research: People
Article Title: Potentially Inappropriate Medications, Frailty, and Outcomes in Patients With Cancer Managed in a National Health Care System
News Publication Date: 10-Sep-2025
Web References:
- JNCCN Article – Potentially Inappropriate Medications, Frailty, and Outcomes
- JNCCN Commentary – The Last Word
- NCCN Guidelines for Older Adult Oncology
- Previous GO-PIMs Validation Study (August 2022)
Image Credits: NCCN
Keywords: Older adults, Cancer research, Cancer treatments, Oncology, Cancer, Geriatrics, Gerontology, Medications, Pharmacology, Drug interactions
