Deprescribing call for lung cancer patients taking unnecessary medicines

De-prescribing will help relieve the pill burden for lung cancer patients who are often taking unnecessary preventive medications such as statins and antihypertensives in the advanced stages of their disease, a study shows.

A retrospective review of medical records for patients who died of lung cancer found that up to 80% were taking preventive medications such as antihypertensives, lipid lowering agents  and antiplatelet drugs when admitted to hospital.

The study of 316 patients with primary non-small cell or small-cell lung cancer who had been admitted in the last six months of life to US and UK hospitals in 2013 found that they were taking around three inappropriate preventive medications.

At the US site 80% of a total 191 patients were taking preventative medications at admission, with the most common being antihypertensives (51% of patients), lipid lowering agents (32%) and antiplatelet drugs (20%). The mean number of preventative medications prescribed was 2.6 on admission, and vitamins and minerals were also commonly prescribed, taken by 56% of patients at admission.

Similar patterns were seen among lung cancer patients admitted at a UK hospital, with  73% of 125 patients taking preventative medications on admission, including antihypertensives (47%),  lipid lowering drugs (46%) and antiplatelet drugs (30%).

Some deprescribing occurred in hospitals, with rates of preventive medication use falling to 69% in the US patients at hospital discharge and 63% at discharge for UK lung cancer patients, according to the findings published in British Journal of Clinical Pharmacology.

The authors said polypharmacy and inappropriate medication in a palliative setting created a pill burden for patients already taking multiple medications and could increase risk of severe drug interactions, possibly resulting in hospitalisation or death.

“There may be scope to develop an intervention that embraces the principles of deprescribing at the point of hospital discharge to reduce inappropriate prescribing in lung cancer patients,” said the authors led by Dr Adam Todd (PhD) from the School of Pharmacy, Faculty of Medical Sciences at Newcastle University, UK.

Lung cancer patients were frequently hospitalised in the final year of life, most often for pain, respiratory distress and GI issues, making discharge an opportunity for introducing de-prescribing interventions, they suggested.

“Our work shows that the point of discharging a patient from hospital might be an appropriate place to develop an intervention to reduce or start the process of reducing burdensome preventative medication that is no longer appropriate given a patient’s reduced life expectancy.”

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