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There are multiple ways to reduce polypharmacy in the cancer population. NCCN guidelines recommend additional medication review for patients taking 5 or more medications. This review should focus on adherence, medication duplication, appropriate use and potential drug interactions. Involvement of pharmacists in this process has been shown to have favorable impact. Oncology Acute Care for Elders (OACE) study explored the benefit of an outpatient pharmacist-based intervention. This study found that 53% of cancer patients had a change in their medication regimen and 28% had an identified medication discontinued. 
Implementation of non-pharmacologic treatment options can be beneficial in avoiding or reducing the dose for medications used to treat specific symptoms. For example, NCCN guidelines recommend cognitive behavioral therapy for insomnia prior to starting hypnotics. Patient with ongoing pain syndromes may benefit from early interactions with physical therapy or Physical Medicine and Rehabilitation physicians. Integrative medicine also presents treatment options such as acupuncture and massage that have shown benefit in addressing cancer related side effects including peripheral neuropathy, chronic pain, sleep and hot flashes. 
The survivorship and supportive care clinic can partner with patients during and after treatment to assist them in understand their non-pharmacologic treatment options. Patient input directs that overall goals are incorporated to create a personalized treatment plan. Follow up with the survivorship visits allow for reassessment of symptoms and reassessment of recommendations based on outcomes.
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