Shots: 

• Megestrol, an appetite stimulator is listed as an inappropriate medication based on the American Geriatrics Society (AGS) Beers Criteria and is considered a high-risk medication for elderly people by the Pharmacy Quality Alliance 

• In a study by the US Oncology Network, the use of megestrol was reviewed and weight gain benefits was evaluated in elderly patients with cancer 

• Today, we have with us Gunjan Sharma from the US Oncology Network shedding light on the prescribing pattern of megestrol in Medicare cancer patients 

Saurabh: What sparked your interest in analysing the prescribing habits of megestrol within the Medicare cancer population in our community oncology network?  

Gunjan: Adherence to Beer’s criteria has been used to measure quality of care by many entities. Several medications that oncology patients receive are a part of the Beer’s criteria. We picked one example of a frequently used medication to assess adherence to Beer’s criteria and evaluate the benefits of using this medication. We used the Medicare population as it represented geriatric patients to whom the Beer’s criteria applies. 

Saurabh: How do you see the American Geriatrics Society’s Beers Criteria and the Pharmacy Quality Alliance classification shaping the decisions when it comes to prescribing medications like megestrol for elderly cancer patients?  

Gunjan: Physicians strive to follow evidence-based medicine, however there is not a substantially large body of evidence specific to Oncology patients and particularly for supportive care in oncology. 

We look at some of the Beer’s Criteria and the Pharmacy Quality Alliance classifications as evidence-based criteria guiding providers with appropriate prescribing of supportive care medications like Megestrol. 

Saurabh: Could you walk us through the journey of conducting this study and how it felt to explore the potential benefits of megestrol in aiding weight gain among elderly patients battling cancer?  

Gunjan: Our process started with identifying the correct cohort of patients. We used a cohort of patients with age greater than 65 years who received megestrol as our base population. We obtained pre and post weights from the electronic health records for the patients receiving megestrol to evaluate if there was meaningful weight gain in the 12-week follow up period from the initial date of prescription. Literature has shown that patients generally start to see responses within 12 weeks, so we use that as our yardstick to see if patients had a response with weight gain within 12 weeks and we didn't find any statistically significant weight gain. 

Saurabh: How do you think doctors can balance following rules about which medicines to give, like the Beers Criteria, with the real need for drugs like megestrol in some situations, especially after seeing what this study found?  

Gunjan: We look at the Beer’s criteria as well as our study as a source of establishing the body of evidence and creating the much-required guidance for providers, and not necessarily as rules that supersede a physician’s decision making. These evaluations and studies are not a substitute for medical decision making and individualizing any given patient's care. 

However, we do hope that as the body of evidence grows and physicians adapt evidence-based medicine these studies will aid in furthering positive quality interventions and benefit patients while minimizing the adverse effects that some of these medications bring about. 

Saurabh: From your perspective, why is it significant to investigate the potential link between megestrol usage and thromboembolic adverse events, particularly in the context of cancer patients, and what kind of impact could this research have on future patient care?  

Gunjan: Our evaluation aimed to validate the use of megestrol for appetite stimulation and weight gain as an outcome. However, we also acknowledge that Megestrol has known adverse effects. Megestrol is known to increase the risk of thromboembolic events. While we studied whether there was a benefit to using Megestrol, we didn’t evaluate any of the potential harms it can cause. Moreover, cancer patients generally at high risk of thrombotic complications, and that risk increases even further with medications like megestrol. This assessment is crucial to better understanding the medication's risk-benefit profile, particularly among cancer patients. 

Saurabh: How do you envision integrating the findings of this study into day-to-day decision-making processes regarding the prescription of megestrol for elderly cancer patients in our community oncology settings?  

Gunjan: The integration of this study’s findings into the prescription practices for megestrol in elderly cancer patients requires a nuanced approach. One can argue that the use of Beer’s criteria and the like should be expanded. While the Beers criteria provides a broad framework, it is essential to tailor these guidelines to the specific needs of oncology patients. Furthermore, the development of these guidelines must be evidence-based, drawing from a robust body of research, particularly from real-world patient experiences. This will ensure that the complex needs of the oncology patient population are met, leading to more effective and personalized care, driving better outcomes. 

Image Source: Canva 

About the Author: 

Gunjan Sharma 

As a Sr. Business Intelligence Analyst at The US Oncology Network, McKesson, I apply analytics skills and over eight years of experience in healthcare data analytics to support value-based care initiatives and strategies. I work with a diverse team of clinicians, researchers, and business leaders to evaluate clinical and claims data, identify population trends, and measure performance across various quality and cost metrics. 
My mission is to use data insights to improve patient outcomes, reduce costs, and optimize care delivery. I am skilled in developing and implementing value-based care models, and interpreting complex healthcare data to drive decision-making. I am also a strong communicator adept at translating complex findings into actionable insights and recommendations for internal and external stakeholders. I am passionate about leveraging data to enhance healthcare quality and efficiency. 

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