Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study
- 15 November 2022
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Journal of Clinical Pharmacy
- Vol. 45 (1), 174-183
- https://doi.org/10.1007/s11096-022-01506-4
Abstract
Background Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications. Aim To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting. Method Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65–94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC). Results 94.5% of patients had at least one other health condition (median 3, IQR 2–5). The median number of medications increased from five (IQR 3–7) seven days before death, to 11 medications on the day of death (IQR 9–15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13–1.37), version 2: 1.30 (1.16–1.48)); OncPal 1.13 (1.01–1.27); PIP-CPC 0.70 (0.61–0.82)). Conclusion This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.Keywords
Funding Information
- Irish Cancer Society (PAL17CAD)
- All Ireland Institute of Hospice and Palliative Care (PAL17CAD)
- Royal College of Surgeons in Ireland (Clement Archer Scholarship)
- Health Research Board (RL-15-1579)
This publication has 49 references indexed in Scilit:
- Pharmacological management of co-morbid conditions at the end of life: is less more?Irish Journal of Medical Science, 2012
- Inappropriate PrescribingDrugs & Aging, 2012
- Polypharmacy, Adverse Drug Reactions, and Geriatric SyndromesClinics in Geriatric Medicine, 2012
- Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing DatabaseEuropean Journal of Clinical Pharmacology, 2012
- Trajectory of Performance Status and Symptom Scores for Patients With Cancer During the Last Six Months of LifeJournal of Clinical Oncology, 2011
- Potentially inappropriate prescribing and cost outcomes for older people: a national population studyBritish Journal of Clinical Pharmacology, 2010
- Prescribing in Palliative Care as Death ApproachesJournal of the American Geriatrics Society, 2007
- Primary Prevention of Cardiovascular Diseases With Statin TherapyArchives of Internal Medicine, 2006
- Reconsidering Medication Appropriateness for Patients Late in LifeArchives of Internal Medicine, 2006
- Statins in Stroke Prevention and Carotid AtherosclerosisStroke, 2004