Potentially inappropriate medication discontinued or changed based on pharmacists’ recommendations in older end-stage cancer patients receiving palliative care: a cross-sectional study

Abstract

Background: Avoiding potentially inappropriate medications (PIMs) can reduce adverse events in older cancer patients receiving palliative care. However, studies have not examined the extent to which pharmacists' recommendations reduce the prescription of PIMs. Therefore, we designed a cross-sectional study to determine the extent to which their recommendations play a role in reducing the prescription of PIMs for older cancer patients receiving palliative care.Methods: Patients brought their medications with them upon admission to the hospital. These medications were examined by pharmacists and deemed inappropriate based on the Screening Tool of Older People's Prescriptions version 2 (STOPP2). In this study, these 220 patients were surveyed, and the percentage of medications that were discontinued or changed based on pharmacists' recommendations was compared with previously published results of similar studies on older non-cancer inpatients, using univariate analysis.Results: A total of 218 PIMs were detected in 1261 medications administered to 220 patients. Of these, 61 medications were discontinued or changed based on the recommendation of pharmacists (rate of discontinuation/change of medications: 28.0%). The univariate analysis results showed that this rate of discontinuation or change of medications was significantly lower than that of a previous report intended for non-cancer patients (40.6%). The rate of discontinuation/change of medications for benzodiazepines was extremely low, but for other drugs it was almost the same as in the previous report.Conclusions: In the case of older end-stage cancer patients receiving palliative care, compared with older patients hospitalized for other diseases, it was more difficult, on pharmacists' recommendations, to discontinue or change PIMs detected by STOPP2. The low significance of discontinuing or changing benzodiazepines in subjects was a major reason it was difficult to reduce the prescription and, eventually, administer PIMs based on pharmacists' recommendations.

Prescription trends at the end of life in a palliative care unit: observational study

“…Deprescribing is a complex process that requires a careful assessment of the benefits and harms for patients and requires shared decision-making between doctors, patients, and pharmacists, which is not always easy [ 4 , 12 , 18 , 21 , 22 , 26 ]. Frequent and systematic re-evaluation of the adequacy and safety of the prescription over time- as well as the appropriateness and effective cessation- are required [ 3 , 13 , 20 , 21 ].…”

Clinical impact and cost‐saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer

“…[20][21][22][23][24] Few studies were conducted in inpatients settings, although hospitalized patients may be fragile, with acute conditions or cancer progression. [25][26][27] Deliens et al reported the only comprehensive intervention at both admission and discharge in a geriatric oncology unit, in 91 patients ≥70 years. 25…”

“…In previous evaluations of pharmaceutical care interventions in older patient with cancer, pharmacists identified DRPs in up to 95% of patients and enabled the resolution of up to 40% of DRPs 20–24 . Few studies were conducted in inpatients settings, although hospitalized patients may be fragile, with acute conditions or cancer progression 25–27 . Deliens et al reported the only comprehensive intervention at both admission and discharge in a geriatric oncology unit, in 91 patients ≥70 years 25 .…”