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Pharmacological management of co-morbid conditions at the end of life: is less more?

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Abstract

Background

Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.

Objectives

The objectives are to determine prescribing practice, for CMCs, in a single SPC service.

Methods

Patients referred to a single specialist palliative care (SPC) service, who died between 1/8/2010 and 30/9/2012, were identified. Medical notes were reviewed, and data collected on prescribing at 3 months, 1 month, and 1 week prior to death.

Results

Fifty-two patients with a median age of 74.5 years were identified; 41 patients (79 %) had a malignant condition. 50 % died in hospital. Patients had a mean of three CMCs. A mean of 4.6 medications for CMCs were prescribed to patients over 65. A mean of 10 medications in total were prescribed at 1 week before death. One week before death, one-third of patients continued to be prescribed aspirin, and over one-quarter a statin.

Conclusions

Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice.

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References

  1. Coebergh JWW, Janssen-Heijnen MLG, Post PN et al (1999) Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of the Netherlands in 1993–1996. J Clin Epidemiology 52(12):1131–1136

    Article  CAS  Google Scholar 

  2. Feinstein AR (1985) On classifying cancers while treating patients. Arch Int Med 145:1789–1791

    Article  CAS  Google Scholar 

  3. Ryan C, O’Mahony D, Kennedy J et al (2009) Potentially inappropriate prescribing in an Irish elderly population in primary care. B J Clin Pharmacol 68(6):936–947

    Article  Google Scholar 

  4. Walsh EK, Cussen K (2010) “Take ten minutes”: a dedicated ten minute medication review reduces polypharmacy in the elderly. Ir Med J 103(8):236–238

    PubMed  CAS  Google Scholar 

  5. Amarenco P, Labreuche J, Lavallee P (2004) Statins in stroke prevention and carotid atheroscelerosis: systematic review and up-to-date meta-analysis. Stroke 35:2902–2909

    Article  PubMed  CAS  Google Scholar 

  6. Uretsky BF, Young JB, Shahidi FE et al (1993) Randomised study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED investigation group. J Am Coll Cardiol 22(4):955–962

    Article  PubMed  CAS  Google Scholar 

  7. Stevenson J, Miller C, Abernethy AP et al (2004) Managing comorbidities in patients at the end of life. BMJ 329:909–912

    Article  PubMed  Google Scholar 

  8. Silveira MJ, Segnini Kazanis A, Shevrin MP et al (2008) Statins in the last six months of life: a recognizable life-limiting condition does not decrease their use. J Pall Med 11(5):685–693

    Article  Google Scholar 

  9. Sheehy-Skeffington B, McLean S, Bramwell M, O’Leary N, O’Gorman A (in press) Caregivers experiences of managing medications of palliative care patients at the end of life—a qualitative study

  10. Garfinkel D, Mangin D (2010) Feasibility study of a systematic approach for discontinuation of multiple medications in older adults. Arch Intern Med 170(18):1648–1654

    Article  PubMed  Google Scholar 

  11. Heeschen C, Hamm CW, Laufs U et al (2002) Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation 105:1446–1452

    Article  PubMed  CAS  Google Scholar 

  12. McGowan MP, for the Treating to New Target Study Group (2004) There is no evidence for an increase in acute coronary syndromes after short-term abrupt discontinuation of statins in stable cardiac patients. Circulation 110:2333–2335

    Article  PubMed  CAS  Google Scholar 

  13. Arnold EM (1999) The cessation of cancer treatment as a crisis. Soc Work Health Care 29:21–38

    Article  PubMed  CAS  Google Scholar 

  14. Holmes HM, Cox-Hayley JT, Alexander GC et al (2006) Reconsidering medication appropriateness for patients late in life. Arch Intern Med 166:605–609

    Article  PubMed  Google Scholar 

  15. Currow D, Stevenson J, Abernethy A et al (2007) Prescribing in palliative care as death approaches. J Am Geriatr Soc 55:590–595

    Article  PubMed  Google Scholar 

  16. Hanlon JT, Schmader KE, Samsa GP et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

  17. Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 151:1825–1832

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland

    S. McLean, B. Sheehy-Skeffington, N. O’Leary & A. O’Gorman

  2. St Francis Hospice, Station Road, Raheny, Dublin 5, Ireland

    S. McLean

Authors
  1. S. McLean
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  2. B. Sheehy-Skeffington
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  3. N. O’Leary
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  4. A. O’Gorman
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Correspondence to S. McLean.

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McLean, S., Sheehy-Skeffington, B., O’Leary, N. et al. Pharmacological management of co-morbid conditions at the end of life: is less more?. Ir J Med Sci 182, 107–112 (2013). https://doi.org/10.1007/s11845-012-0841-6

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  • DOI: https://doi.org/10.1007/s11845-012-0841-6

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