Reducing the use of preventive medications in people with advanced cancer near the end of life could reduce unnecessary side effects and improve patient quality of life, a new study has found.
The research, which is published online in CANCER, shows that medications, such as those that lower blood pressure or cholesterol, or protect bone health, are commonly prescribed during the last year of life of older adults with cancer, even though they are unlikely to provide meaningful benefits.
Lucas Morin, of the Karolinska Institute, Sweden, and his colleagues evaluated the benefits of preventive drugs among older people with cancer during their final year of life.
Among 151,201 older patients who died with cancer between 2007 and 2013, the average number of drugs increased from 6.9 to 10.1 throughout the last year of life, while the proportion of individuals using 10 or more drugs rose from 26% to 52%.
They found that preventive drugs such as antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics were frequently continued until the final month of life.
Median drug costs during the last year of life amounted to $1,482 per person, including $213 for preventive therapies, and costs for preventive drugs were particularly high in older adults who died from pancreatic, breast, or gynaecological cancers.
“Although the preventive drugs reported in our study are most often pharmacologically and clinically appropriate in the general population, their use in the context of limited life expectancy and palliative goals of care should be examined critically,” said Morin.
“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.”
Morin L, Todd A, Barclay S et al. Preventive drugs in the last year of life of older adults with cancer: is there room for deprescribing? CANCER. 25 March 2019; doi: 10.1002/cncr.32044
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