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Polypharmacy

Older people with terminal cancer 'overprescribed' preventative drugs

Using data from more than 150,000 patients, researchers conclude that there is room for deprescribing of preventative medicines in older people with cancer. 

Older patients with cancer receiving end-of-life care may be overprescribed preventative medicines, study results have shown[1]. The researchers also found that patients’ quality of life could be improved by deprescribing.

Looking at medicines prescribed to 151,201 older people in Sweden, who died from cancer between 2007 and 2013, study authors found that 52% of them were taking ten or more medicines. Preventative medicines including antihypertensives, statins, and oral antidiabetics were frequently continued until the final month of life, the authors said.

These preventative medicines amounted to one-fifth of the total cost of drugs prescribed to these patients, the authors said, and yet may have “limited clinical benefit near the end of life”, because the medicines are ”unlikely to achieve their clinical benefit during the patients’ remaining lifespan”.  The authors suggest that deprescribing of some of these medicines may improve patients’ quality of life by reducing the frequency of side effects.

Study author Lucas Morin, a doctoral student at the Karolinska Institute, Sweden, said: “[Preventative medicines’] use in the context of limited life expectancy and palliative goals of care should be examined critically.

“Our finding that older adults with poor-prognosis cancers — including cancers of the brain, lung, liver, and pancreas — were just as likely as those with less aggressive disease to use preventive drugs during their last month of life suggests that there is room for deprescribing.”

An earlier study by different authors, published in June 2016, found that on average, more than a third of older patients nearing the end of their lives were given drugs which offered no benefit to them given their circumstances.

Mair Davies, director for Wales at the Royal Pharmaceutical Society, said the use of preventative medicines in palliative care had been identified as an important issue during the development of the RPS’s policy Palliative and End of Life Care: Pharmacy’s contribution to improved patient care.

“We continue to advocate that pharmacists should be embedded into multidisciplinary palliative care teams in order to provide expertise on prescribing, deprescribing and medicines use.

”[The Society] also recognises the importance of co-production in palliative care and empowering patients to take control of their health care through discussions about their medicines regimen wherever possible.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206338

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