Use of unlicensed medication in palliative medicine

Todd, Jennifer; Davies, Andrew

doi:10.1177/026921639901300517

Cited by 21 publications

(26 citation statements)

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“…A significant rate of off-label prescribing due to unapproved route of administration (11%) has also been identified [20]. These rates are slightly higher than we identified, but this is not unexpected.…”

Section: Discussionsupporting

confidence: 58%

“…In the specialist palliative care setting the rate of offlabel prescribing due to unlicensed indication has been found to be approximately 15% [1,20]. A significant rate of off-label prescribing due to unapproved route of administration (11%) has also been identified [20].…”

Section: Discussionmentioning

confidence: 99%

“…However, chemotherapy is only one component of treatment provided to patients with cancer. It has also been demonstrated that in specialist palliative care units in the United Kingdom approximately onequarter of medications prescribed are for off-label indications or are given by an off-label route [1,15,20]. The present study was conducted to quantify the extent of offlabel and unlicensed prescribing in a hospitalized oncology population in Australia.…”

Section: Introductionmentioning

confidence: 97%

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Off-label prescribing in oncology

Poole

Dooley

2004

Supportive Care in Cancer

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Off-label prescribing occurs when a practitioner prescribes a drug for a use, or in a manner, not listed in the 'approved product information' (API) for that drug. The literature suggests that this is a frequent occurrence in many areas of medicine, but data are limited in the hospitalized oncology setting. The aim of this study was to quantify the extent of off-label prescribing in a hospitalized oncology population in Australia. The study was conducted at Peter MacCallum Cancer Centre, Australia. On a single day the medication charts of all hospitalized patients were prospectively reviewed. Drug prescribing was assessed for licensing status by comparison with the API as approved by the Therapeutic Goods Administration of Australia. Prescriptions were classified as licensed, off-label or unlicensed. Medication charts of 130 patients were assessed. There were 1351 prescriptions. In 293 (22%) of the prescriptions the drug was either off-label (242, 18%) or unlicensed (51, 4%). Among the 130 patients, 110 (85%) received at least one drug that was prescribed off-label or that was unlicensed. Off-label dosing was the most frequent reason for a drug being off-label (139, 10% of all prescriptions). Off-label due to use for an unapproved indication was found in 118 prescriptions (9%), and off-label due to an unapproved route of administration was found in 38 prescriptions (3%). Off-label prescribing is widespread in the acute hospitalized oncology population, with approximately 22% of all prescriptions being for off-label or unlicensed medication. Such prescribing affects a significant proportion of patients.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Off-label prescribing in oncology

Poole

Dooley

2004

Supportive Care in Cancer

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“…45 But the fact that patients can still obtain care from hospitals and other community services, and alongside hospice and palliative care, means that the more intensive therapies, such as chemotherapy, radiotherapy, transfusion and more expensive treatments such as bisphosphonates for bone pain and hypercalcaemia, to improve symptoms or enhance life, can be given alongside other treatments. [46][47][48] There is also a growing emphasis on providing rehabilitation in hospices and palliative care services. 49 However, in the U.K. the primary focus of much palliative care is cancer.…”

Section: Higginson S-166mentioning

confidence: 99%

End-of-Life Care: Lessons from Other Nations

Higginson

2005

Journal of Palliative Medicine

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Palliative care and hospice services have evolved across the globe in different contexts and in different ways, although many of the challenges faced are similar. Comparison between countries helps to identify the best solutions for individual patients and their families, who have complex needs and problems. This paper describes the globally shared challenges and beginnings in hospice and palliative care. It reviews evolution of services and approaches. It compares the models of hospice and palliative care in the United States and the United Kingdom, where pioneer hospices were developed through the work of Dame Cicely Saunders, and then seeks to highlight ways to learn from the different approaches to address common questions. Several research recommendations result from this review. In many countries the research agenda in palliative and end-of-life care must move from describing need (where there are ample studies) to understanding how and determining whether services and interventions work, for whom, and when. Studies should consider the whole trajectory of illness, particularly in slowly progressive or relapsing conditions (including neurological conditions). Future studies should work toward the use of a similar set of core outcome measures, as well as take advantage of the opportunity to undertake "natural experiments" by comparing and contrasting care systems developed in different contexts around the world.

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“…1 The practice is widespread, particularly in specialties such as paediatrics, pain medicine and palliative care, with up to one quarter of all prescriptions in the latter falling into this category. 2,3 Although such use of drugs is legal, there are implications for prescribers, as outlined in guidelines for best practice produced by regulatory bodies such as the General Medical Council (GMC). However, in a survey undertaken in 1999, we found that <5% of doctors in palliative care would always obtain verbal consent, document in the notes or inform other professionals of such use, as was then recommended by the GMC.…”

Section: Introductionmentioning

confidence: 99%