Study Evaluates Prescription Drug Prescription at End of Life in Elderly Cancer Patients

New Study Reveals Preventative Medications, such as those aimed at lowering blood pressure or cholesterol, or protecting bone health, among others, are commonly prescribed in the last year of life of older people with cancer even if it's unlikely to provide significant benefits. Posted online early in CANCER, a peer-reviewed journal of the American Cancer Society, the findings underscore the need to make efforts to reduce the burden of drugs with limited clinical benefit at end-of-life.

Many older people take multiple medications simultaneously, which increases the risk of serious side effects. For elderly patients with cancer, the benefit of each additional drug gradually decreases while the risk of harm increases as the disease progresses and the prognosis deteriorates. The benefits of preventative medications can be particularly limited as these drugs often take years to reach their goal. In the context of advanced cancer, the added value of setting up or pursuing preventive treatment becomes questionable, since the patient's remaining life expectancy may be too short for the patient to be treated. 39, we can observe the expected benefits.

There is little information on the extent to which these drugs are prescribed to patients with advanced cancer before death. Lucas Morin, MS, of the Karolinska Institute, and his colleagues evaluated the prescription of preventive medications throughout the last year of life of elderly people with cancer who died between 2007 and 2013 in Sweden . The team also estimated the direct costs of these preventative medications.

Of the 151,201 elderly cancer patients who died, the average number of medications increased from 6.9 to 10.1 in the last year of life and the proportion of individuals using 10 or more drugs has increased from 26% to 52%. Preventive medications, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins and oral antidiabetic drugs, have often been continued until the last month of life.

The median cost of drugs in the last year of life was $ 1,482 per person, including $ 213 for preventive treatments. Preventive drugs accounted for about one-fifth of the total cost of prescription drugs, and this proportion only slightly decreased with the approach of death. The cost of preventative medications was particularly high in elderly people who died from pancreatic cancer, bad cancer or gynecological cancers.

The findings suggest that reducing the use of preventative medications in people with advanced end-of-life cancer could potentially not only reduce unnecessary side effects and improve the quality of life of patients, but also reduce the financial burden of patients.

"Although the preventative drugs reported in our study are most often pharmacologically and clinically relevant in the general population, their use in the context of limited life expectancy and palliative goals in care needs to be critically examined, "Morin said. "Our finding that older people with poor-prognosis cancer – including brain, lung, liver and pancreatic cancers – were just as likely as people with less-than-optimal illness. aggressive to take preventive medication during their last month of life is the place to deprecate ".