Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?
Wastesson, Jonas W
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Morin, L., Todd, A., Barclay, S., Wastesson, J. W., Fastbom, J., & Johnell, K. (2019). Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?. Cancer, 125 (13), 2309-2317. https://doi.org/10.1002/cncr.32044
Background: The continuation of preventive drugs for older patients with advanced cancer has come under scrutiny since these drugs are unlikely to achieve their clinical benefit during the patients’ remaining lifespan. Patients and methods: nationwide cohort study of older adults (≥65 years) with solid cancer who died 6 between 2007 and 2013 in Sweden, using routinely collected data with record linkage. We calculated the monthly utilization and cost of preventive drugs throughout the last year before death. Results: Among 151 201 older patients who died with cancer (mean age 81.3 [SD, 8.1] years), the 9 average number of drugs increased from 6.9 to 10.1. Preventive drugs were frequently continued until 10 the final month of life, including anti-hypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics. Median drug costs amounted to $1482 (interquartile range [IQR] $700–$2896]) per person, including $213 (IQR $77–$490) for preventive therapies. Compared to older adults who died with lung cancer ($205, IQR $61–$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference [AMD] $13, 95% CI $5–$22), or gynaecological cancers (AMD $27, 95% CI $18–$36). There was no decrease in the cost of preventive drugs throughout the last year of life. Conclusion: preventive drugs are commonly prescribed during the last year of life of older adults with cancer and are often continued until the final weeks before death. Adequate deprescribing strategies are warranted to reduce the burden of drugs of limited clinical benefit near the end of life.
Humans, Neoplasms, Prognosis, Terminal Care, Survival Rate, Retrospective Studies, Follow-Up Studies, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Deprescriptions
External DOI: https://doi.org/10.1002/cncr.32044
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289505