Clinical Pearls in palliative medicine

Feely, Molly A.; Litin, Scott C.; Bundrick, John B.

doi:10.1016/j.disamonth.2017.03.013

Cited by 2 publications

(1 citation statement)

References 2 publications

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“…Clinicians may be reluctant to prescribe antidepressants to older adults because of risk of major adverse events such as falls or fractures, 34 intolerable side effects such as nausea and dizziness, or lack of time to receive benefit if prognosis is poor. 35 When we combine antidepressants and anxiolytics, we find that almost half of our study patients received medications for emotional distress. We acknowledge that some patients may receive nonpharmacologic interventions such as psychotherapy or other counseling instead of medication therapy.…”

Section: Discussionmentioning

confidence: 87%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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Context.-Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. Objectives.-We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. Methods.-This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/ vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. Results.-Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. Conclusion.-Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patientprovider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.

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Section: Discussionmentioning

confidence: 87%