Drugs designed to provide long-term health protection are commonly prescribed to patients with advanced cancer and less than a year to live, a new study reveals.
A paper in the journal Cancer, written by Lucas Morin from Sweden’s Karolinska Institute, and colleagues, looked at prescriptions issued in Sweden between 2007 and 2013 for 151,201 older patients who subsequently died of cancer within 12 months.
It is standard for older people, especially those with serious disease, to be prescribed multiple medications. The practice represents a trade-off, which balances symptom management against the increased risk of side-effects.
The researchers found that among cancer patients the average number of drugs prescribed increased from 6.9 to 10.1 in the last year of life. The percentage of patients using 10 or more drugs grew from 26% to 52% during the same life-stage.
A significant portion of medications given, Morin and colleagues discovered, whether as continuing or new drug regimes, were preventative in nature, intended to lower blood pressure and cholesterol, or boost bone health.
In general, but especially as new prescriptions, the researchers conclude, such meds are of little use to-late stage cancer patients, because they take many months to work and remaining lifespan is likely to be too short to see any benefits.
The use of medications that deliver benefits to long-term health for terminal patients, they write, is of no value. At the same time, their presence increases the cost of treatment and boosts the risk of dangerous drug interactions.
“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,” says Morin.
“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.”