Managing comorbidities in patients at the end of life

Abstract

Introduction A 68 year old woman with extensive small cell lung cancer and rapid weight loss also has long term mild hypertension with no evidence of end organ damage. What would you do about her antihypertensive treatment? Stop drug treatment because she has a terminal illness Continue the drugs because you would not want her blood pressure to get worse (and the conversation about stopping them may be difficult because last year you told her she would be taking these drugs for the rest of her life) Wait until she develops postural hypotension and then consider reducing her drugs Reduce her drugs and watch carefully. People with progressive life limiting illnesses are often also taking drugs for treatment or prevention of long term conditions.1 However, little guidance exists to help clinicians consistently and systematically manage chronic comorbidity. Some clinicians stop drugs for chronic conditions arbitrarily because the person has a progressive life limiting illness. At the other end of the therapeutic spectrum, some clinicians do not stop any long term treatments until the patient is unable physically to take them or suffers adverse effects. Competent care for people with life limiting illnesses requires careful management of their long term drugs. We outline some key considerations. Footnotes Illustrative clinical scenarios are presented on bmj.com Contributors and sources DCC and APA are currently leading a national project looking at the evidence base for clinical practice in palliative care. Their clinical practice includes people from a wide range of clinical backgrounds at the end of life(caresearch.com.au). CM is a general physician, much of whose practice deals with chronic complex illness. JS is a registrar doing advanced training in palliative medicine. DCC and APA were responsible for the conception and design of this article. CM and JS contributed to drafting the article and revising it critically. DCC is the guarantor. Competing interests None declared.