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Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
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Number of Authors: 62019 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 125, no 13, p. 2309-2317Article in journal (Refereed) Published
Abstract [en]

Background The continuation of preventive drugs among older patients with advanced cancer has come under scrutiny because these drugs are unlikely to achieve their clinical benefit during the patients' remaining lifespan. Methods A nationwide cohort study of older adults (those aged >= 65 years) with solid tumors who died between 2007 and 2013 was performed in Sweden, using routinely collected data with record linkage. The authors calculated the monthly use and cost of preventive drugs throughout the last year before the patients' death. Results Among 151,201 older persons who died with cancer (mean age, 81.3 years [standard deviation, 8.1 years]), the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics. Median drug costs amounted to $1482 (interquartile range [IQR], $700-$2896]) per person, including $213 (IQR, $77-$490) for preventive therapies. Compared with older adults who died with lung cancer (median drug cost, $205; IQR, $61-$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference, $13; 95% confidence interval, $5-$22) or gynecological cancers (adjusted median difference, $27; 95% confidence interval, $18-$36). There was no decrease noted with regard to the cost of preventive drugs throughout the last year of life. Conclusions Preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death. Adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life.

Place, publisher, year, edition, pages
2019. Vol. 125, no 13, p. 2309-2317
Keywords [en]
deprescribing, drug prescribing, end of life, palliative care
National Category
Geriatrics Cancer and Oncology
Identifiers
URN: urn:nbn:se:su:diva-170831DOI: 10.1002/cncr.32044ISI: 000471065900021PubMedID: 30906987OAI: oai:DiVA.org:su-170831DiVA, id: diva2:1339377
Available from: 2019-07-29 Created: 2019-07-29 Last updated: 2019-07-29Bibliographically approved

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