Reducing potentially inappropriate medications in palliative cancer patients: evidence to support deprescribing approaches

Abstract

Objectives Cancer patients who have transitioned from curative intent chemotherapy or radiotherapy to palliative therapy have limited life expectancies. Due to this, medications for primary and secondary prevention or those with no short-term benefit are potentially inappropriate medicines in this patient group. These medications often have potentially harmful profiles, increasing the patient's adverse drug events, pill burden, and medication costs. This review evaluates the most current evidence to assess the outcomes and potential methods used for identifying and ceasing potentially inappropriate medications (PIMs) in palliative cancer patients. Methods A systematic review of the literature was conducted using the databases Ovid MEDLINE, PubMed, EMBASE, IPA, and CINAHL. Results Of the 51 articles examined in detail, three studies relating to cancer have been evaluated. In these retrospective and cross-sectional studies, the incidence of PIMs was shown in approximately 20 % of patients, although the studies were inconsistent. In addition, six studies were identified that demonstrated the evidence in other population groups; these studies have been selected to establish the evidence in large-scale retrospective studies, prospective cross-sectional studies, both demonstrating the prevalence of PIMs, as well as the outcomes of ceasing PIMs. Conclusion There is evidence that PIMs are commonly prescribed in palliative care patients. There are no studies that have identified the impact of ceasing PIMS in this setting. Published tools and implemented strategies have focused on the elderly populations. Further research is warranted in establishing clear guidelines for the identification of PIMs in palliative cancer patients as well as interventional studies assessing the outcomes of ceasing PIMs in these patients.

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

“…Twenty-four of these articles were non-systematic reviews/editorials/commentaries [1,12,, three systematic reviews [43][44][45], five original research articles [46][47][48][49][50], one letter to the editor [51], two newsletters [52,53], one master thesis [54] and one conference paper [55]. The vast majority of the articles were published by an Australian first author (n = 26, five US, two UK, two Canada, one France, one Italy).…”

“…The characteristic of medication cessation is at the core of deprescribing (regardless of the specific word used, however, withdrawal was the most favoured). This characteristic occurred in all but two articles, where medication cessation was implied: limiting polypharmacy [38] and rationalization of medications [45]. Two of the included characteristics, that the medication to be ceased is inappropriate and that it is supervised by a health care professional, are important to distinguish deprescribing from what it is not -non-adherence or denying effective treatment.…”

Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review

“…The most recent, a review by Lindsay et al ,43 focused exclusively on patients with cancer and concluded that there is evidence that potentially inappropriate medications are commonly prescribed in patients with cancer. A recent review by Tjia et al ,44 who focused on intervention studies that reduced unnecessary medication in frail elderly patients, concluded that there was a lack of robust high-quality evidence in this area, and more work was needed to inform evidence-based approaches to deprescribing medication.…”

Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes

“…Todd et al and Lindsay et al showed the potential to stop medicines in patients with lung cancer 17 18. Todd et al showed that the majority of their patients with lung cancer were taking medicines that could be stopped and in some cases were taking medicines that interacted with the cancer treatment 18…”