Literature Review

Too Much, Too Little, Just Right: Optimizing cancer care for older adults The ASCO Post, American Society of Clinical Oncology; by Ramy Sedhom, MD; Bobby Green, MD; and Julia  Frydman, MD, MS; 9/10/24 Imagine walking into a fancy restaurant only to find a menu consisting mostly of kids’ dishes. It would make no sense. Just 25% of restaurant diners are younger than age 12, and they rarely write Yelp reviews. But when it comes to cancer treatment, this is not very far from what we do. The median age for a new cancer diagnosis is 67, and among those who die of cancer each year, 73% are older adults. Yet just one in four clinical trial participants is aged 70 or older. Consequently, guidelines for most new cancer therapies are based on a median age that is significantly younger than the patient population who actually receives these therapies. That’s quite a conundrum. More than half of patients older than age 65 experience toxicity of grade 3 or worse while undergoing standard chemotherapy. ... Palliative Care—For a 40-year-old mother of two young children, the goal of cancer treatment is usually clear: complete remission and long-term survival. But when you ask older patients with cancer about their priorities, a majority regard symptom control, emotional coping, and other quality-of-life measures at least as much as longevity and sometimes more.

Beers Criteria update for medication use in older adultsMedscape Nurses; by Linda Girgis; 8/30/24Primary care physicians know the complexities of treating older patients, from increased complications from medications and procedures to comorbidities stemming from having multiple medical conditions. The Beers Criteria were established by the American Geriatrics Society as a guide for physicians about medications that may possess more risks than benefits in older patients, specifically those aged 65 years and older. There are approximately 100 medications on the list. Criteria used to establish the list include medications to avoid over the age of 65 in an outpatient setting, medications to avoid in certain medical conditions, medications to avoid that may interact with other medications, medications to avoid with renal impairment, and medications to avoid where harmful side effects outweigh the possible benefits. The American Geriatrics Society updates the list as new published evidence becomes available.

The importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]

Medical marijuana study details Arkansans’ use of the drug, raises questions from lawmakers Arkansas Times; by Tess Vrbin for the Arkansas Advocate; 8/15/24 ... The study, conducted by the Arkansas Center for Health Improvement, is the first ever population-based study of medical marijuana funded by a federal health agency, the National Institutes of Health. ... The state currently has more than 105,000 cardholders, an increase of roughly 29,000 in three years, according to ACHI’s study. ... Lawmakers on the Joint Public Health, Welfare and Labor Committee ... expressed concerns about some of the information in the study, such as the fact that one-third of the certifications for medical marijuana cards in 2021 came from just seven doctors, with little evidence of a physician-patient relationship in many cases.Thirty-eight states and the District of Columbia have legalized marijuana to some extent, and Arkansas is one of 14 states in which the drug is legal only for medicinal purposes.

Biden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates. 

Exploring AI-powered music therapy as a solution to chronic pain management and the opioid crisisNeurologyLive; by Neal K. Shah; 8/6/24While the opioid crisis continues to ravage communities across America, many with chronic pain are in dire need of solutions. As a result, healthcare providers and researchers are urgently seeking alternative treatments for chronic pain management. One innovative solution is the use of music therapy, particularly when enhanced by artificial intelligence (AI) and neurotechnology. This combination could offer a powerful, non-pharmacological intervention to help millions of Americans suffering from chronic pain while potentially reducing opioid dependence.

Top PBM executives grilled in contentious congressional hearingModern Healthcare; by Michael McAuliff; 7/23/24Lawmakers and executives from three major pharmacy benefit managers presented diametrically opposing views at a heated Capitol Hill hearing Tuesday, as major bills aimed at reining in the organizations remain stalled in Congress. Members of the House Committee on Oversight and Accountability blamed the highly concentrated PBM industry for raising drug prices and running independent pharmacies out of business, while leaders from CVS Caremark, Express Scripts and Optum Rx all countered that the sector in fact lowers prices and supports local pharmacies.

AIDS Healthcare Foundation files Antitrust Action against Express Scripts PBM AIDS Healthcare Foundation (AHF), Los Angeles, CA; by Ged Kenslea; 7/29/24 AIDS Healthcare Foundation (AHF) – the world’s largest HIV/AIDS healthcare organization which cares for more than 195,000 people in the United States and is an essential safety-net provider for disenfranchised, high-risk HIV/AIDS populations – has filed a federal lawsuit (U.S.D.C., E.D. Mo., Case No. 4:24-01043) against the pharmacy benefit manager (PBM) Express Scripts, Inc. and its subsidiary, Accredo Health Group, Inc. AHF asserts federal antitrust claims and claims of state unfair trade practices over Express Scripts’ use of its monopoly power as a PBM in Louisiana to impose anticompetitive restraints to destroy competition among specialty pharmacies like AHF’s. AHF’s lawsuit comes on the heels of a blistering 115-page FTC report documenting how powerful PBMs like Express Scripts squeeze mom-and-pop and independent pharmacies, driving many out of business.

Humana to takeover 23 Walmart Health locations with new CenterWell senior care clinics. Here's where Louisville Courier Journal; by Olivia Evans; 7/25/24 Humana, the Louisville-based health insurance giant, has announced its health care services branch of the company, CenterWell, will open 23 senior primary care centers in Walmart Supercenters. The centers will operate under the CenterWell Senior Primary Care and Conviva Care Centers brand names, according to a press release from Humana.

Education curricula need to incorporate whole-person care beyond electives Pharmacy Times; by Ashely Gallaher; 7/21/24“[Whole-person care is] simply caring for a person and not just their pills. It's making sure that we're focusing on medications as tools to help people live better, healthier lives, and not as the focus of their lives,” Kashelle Lockman, PharmD, MA, clinical assistant professor and clinical pharmacy specialist at the University of Iowa. ... 3 Key Takeaways:

New medication, staging criteria signal a potential shift in Alzheimer’s care Psychiatric News; by Linda M. Richmond; 7/12/24 The latest antibody treatment for Alzheimer's disease may prompt the industry toward the use of biomarkers--rather than traditional cognitive and functional testing--for diagnosis and staging. Will the new drug make a meaningful difference in patients' lives despite its risks and hefty price tag?

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

2 Ketamine palliative care projects explore interdisciplinary collaborationHospice News; by Holly Vossel; 6/29/24Two ketamine-assisted therapy projects are examining ways to develop training and collaboration models for utilization among palliative care patient populations. A growing body of research is uncovering the potential benefits of ketamine therapies to help with symptom management. But greater understanding of the drug and its impacts is needed to help palliative care providers and other health professionals guide patient experiences, according to Dr. Michael Fratkin, board president of the Institute for Rural Psychedelic Care. Fratkin is also a palliative care specialist at Humboldt Center for New Growth.