Preventative Medications Unnecessarily Prescribed to EOL Patients With Lung Cancer

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Previous studies have indicated that preventative medications are often inappropriately prescribed to patients with lung cancer.
Previous studies have indicated that preventative medications are often inappropriately prescribed to patients with lung cancer.

Patients with lung cancer may be prescribed inappropriate preventative medications on hospital discharge, leading to unnecessary cost and negative clinical outcomes, according to a study published in the British Journal of Clinical Pharmacology.1

Lung cancer is commonly accompanied by comorbid conditions, including cardiovascular, cerebrovascular, and chronic obstructive pulmonary diseases, leading to polypharmacy and high pill burden among this patient population. Previous studies have shown that these preventative medications are often inappropriately prescribed, which not only have limited benefit but also increase the risk of severe drug-drug interactions at the end of life. 

For this retrospective study, researchers assessed the outcomes of 316 patients with advanced non-small cell or small cell lung cancer from 2 sites in the United States and United Kingdom, who were admitted to the study site at least once within 6 months of death. Patients' medication use at hospital admission and at discharge prior to death due to lung cancer was evaluated. 

Analysis showed that the mean number of preventative medications was 1.9 and 2.6 on admission, and 1.7 and 1.9 at discharge at the UK and US sites, respectively. 

The most commonly prescribed preventative medications in the United Kingdom were anti-hypertensives, and in the United States consisted primarily of vitamins and minerals. The least commonly prescribed medication in both sites was antidiabetes agents. 

Further analyses showed significant associations between the number of preventative drugs at admission and discharge, and also between the total number of drugs on discharge and the number of preventative medications at discharge. No other indications (eg, age, cancer stage, cancer type, number of hospitalizations) were found to be significantly predictive of the number of medications on discharge.

The authors concluded that “there may be scope to develop an intervention that embraces the principles of deprescribing at the point of hospital discharge to reduce inappropriate prescribing in lung cancer patients.”

Reference

Todd A, Al-Khafaji J, Akhter N, Kasim A, Quibell R, Merriman K, Holmes H. Missed opportunities: unnecessary medicine use in patients with lung cancer at the end of life: an international cohort study[published online September 5, 2018]. Br J Clin Pharmacol. doi: 10.1111/bcp.13735.

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