Prescription is Futile: A Prospective Cohort Study of Futile Medications in Hospice Care (FR416-C)

Abstract

3. Generate hypotheses to explain current octreotide prescribing patterns.Background. Medical management is the cornerstone of malignant bowel obstruction (MBO) therapy and includes antisecretory agents such as octreotide. Currently, no data exist regarding octreotide prescribing patterns in US academic hospitals in the palliation of inoperable MBO. Research Objectives. To assess octreotide prescribing patterns to palliative inoperable MBO including: inpatient service, initiation day, daily dose, length of stay (LOS), and overall survival (OS). Method. This retrospective chart review evaluated inpatient MBO admissions at a single academic US hospital between 2008-2011. Patients with operable lesions or non-MBO diagnoses were excluded. The prescribing primary service (medical vs. surgical), inpatient day initiated, daily dose, cumulative dose, LOS, and OS were analyzed. A multiple linear regression analysis was used to assess if the association between dose and LOS was significant. Kaplan-Meier curves and log rank test were used to evaluate OS. Result. 767 total patients who received octreotide were identified, 134 cancer patients, and 37 (24 female, 13 male; mean age 56.7 years) had a confirmed inoperable MBO. The mean LOS was equivalent on both services (17 days). The mean octreotide dose was 201.2 mcg medical vs. 119 mcg surgical. Mean initiation was 8.4 days (7.9 medical vs. 8.8 surgical). Earlier initiation was associated with a shorter hospital stay (Spearman's correlation ¼ 0.76, p < 0.0001). No serious adverse effects were attributed to octreotide. No statistically significant association between average daily dose, cumulative dose, and OS was demonstrated.Conclusion. Early initiation of octreotide is statistically significantly associated with shorter LOS; the significance remains after adjustment for age. Timing and dosage of octreotide use was not significantly associated with survival.

Antiretroviral Therapy at the End of Life

“…It is very interesting to note that the majority of visits occurred during the last 6 and 3 months of life. This correlates with the findings in some studies showing that medications in patients admitted in hospice settings are carried over 11 Solid evidence is lacking to guide optimal pharmacotherapy in most end-of-life settings, especially in noncancer diseases and very old patients. 12 This situation is illustrated in the case of patients with dementia admitted to hospice settings, where no clear guidelines have been developed in relation to discontinuation of therapy.…”

“…Anticoagulant and antiplatelet medications (36%), Alzheimer treatments (18%), electrolytes (14%), and appetite stimulants (9%) were the most prevalent medications considered questionable. 11 In our study, approximately 73% of the patients were on antiretroviral therapy during the last clinic visit. It is very interesting to note that the majority of visits occurred during the last 6 and 3 months of life.…”