A complex cocktail: polypharmacy, potentially inappropriate medications and palliative cancer patients.     — ASN Events
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A complex cocktail: polypharmacy, potentially inappropriate medications and palliative cancer patients.     (#152)

Emily D'Arcy 1 , Michaela Del Campo 2 , Timothy To 3 , Ganessan Kichenadasse 1 4 5 , Helen Martin 1
  1. Flinders Medical Centre, South Australia Health, Bedford Park, SA, Australia
  2. Central Adelaide Palliative Care Services, South Australia Health, Adelaide, SA, Australia
  3. Southern Adelaide Local Health Network, South Australia Health, Adelaide, SA, Australia
  4. Flinders University, Adelaide, SA, Australia
  5. Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia

Background

Patients with progressive, advanced cancer are frequently on multiple medications for management of comorbid disease, disease prevention and symptom management. The benefits of preventative medications may cease to outweigh the harms of therapy, and hence be considered potentially inappropriate medications (PIMs). These PIMs contribute to the burden of polypharmacy in palliative cancer patients, and thus the risk of iatrogenic harm.

Aim

To investigate the incidence of PIMs and polypharmacy in palliative cancer patients admitted to a South Australian tertiary teaching hospital.

Methods

The case notes of oncology inpatients with limited prognosis were retrospectively reviewed. The incidence of PIMs and polypharmacy on admission to, and discharge from, hospital were collected. PIMs were identified using the OncPal deprescribing guideline1. Polypharmacy was defined as ≥5 medications.

Results

Records of 91 patients were reviewed at the time of submission. Of those reviewed, 70% were prescribed PIMs and 78% were exposed to polypharmacy. The average number of PIMs, per patient, decreased from admission to discharge (2.2+1.9 vs 1.8+1.7, p=0.006). Despite this decrease in PIMs, the average number of medications on discharge (7.7+3.8) was significantly greater than on admission (6.4+4.4, p<0.001). This shift was attributed to a 42% increase in medications for symptoms on discharge, by comparison to admission (p<0.001). The most common PIMs on admission (n=176) included complementary medications (31%) and antihypertensive medications (30%). Complementary medications and antihypertensive medications were those most commonly deprescribed (33% and 23% of cases, respectively). On discharge, the most common PIMs (n=145) included complementary medications (30%), antihypertensive medications (28%) and dyslipidemia agents (20%).

Conclusions

Palliative cancer patients are often burdened by polypharmacy and PIMs. These findings indicate that there is scope for clinicians to utilise the OncPal deprescribing guideline to facilitate rational deprescribing and in turn, reduce the incidence of polypharmacy and PIMs.  

  1. Lindsay, J, Dooley, M, Martin, J, Fay, M, Kearney, A, Khatum, M & Barras, M 2015, The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline’, Support Care Cancer, vol. 23, pp. 71-78.
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