Deprescribing Preventive Drugs Near End of Life in Cancer May Reduce Burden

A new study suggests that common preventive medications may add an unnecessary burden in older adults with cancer approaching end of life, warranting deprescribing strategies to reduce the burden of medications that provide limited clinical benefit.

Taking multiple medications concomitantly can increase the risk of adverse effects and potential harm. Although these preventive therapies may be clinically appropriate, they may be unlikely to achieve meaningful clinical benefit in patients with advanced cancer who have a limited life expectancy, according to the study. Continued prescribing of preventive therapies may add unnecessary cost and burden, indicating that deprescribing efforts may be considered in the context of palliative care.

The study, published in the peer-reviewed journal Cancer, looked at a nationwide cohort of older adults with solid tumors in Sweden who died between 2007 and 2013. Using routinely collected data, the researchers calculated both the monthly cost of preventive drugs and the cost for these treatments through the last year before the patient’s death. However, according to the researchers, there is limited information on the extent to which such medications are prescribed to patients with advanced cancer before their death.

Of the 151,201 older patients in the study who died with cancer, the average number of drugs increased from 6.9 to 10.1 over the course of the last year before their death. Additionally, the proportion of patients using 10 or more drugs rose from 26% to 52%, according to the data. The study showed that preventive drugs, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics, were frequently continued until end of life.

Per person, median drug costs amounted to $1482, with preventive therapies accounting for $213. The researchers found that costs for preventive drugs were higher among older patients who died from pancreatic cancer or gynecological 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,” study author Lucas Morin, MS, of the Karolinska Institute, said in a press release. “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.”

Reducing the use of these medications near end of life may help mitigate unnecessary adverse effects, improve patient quality of life, and ease financial burdens, the researchers concluded.

References

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. March 25, 2019. https://doi.org/10.1002/cncr.32044

Are Preventive Drugs Overused at the End of Life in Older Adults with Cancer [news release]. Wiley. https://newsroom.wiley.com/press-release/cancer/are-preventive-drugs-overused-end-life-older-adults-cancer. Accessed March 25, 2019.