Modification of cardiovascular pharmacotherapy in palliative care patients with cancer: a narrative review

Palliative care patients with cancer are treated with many drugs, especially at the end of life. Limiting polypharmacy decreases the risk of associated adverse effects, medical errors, and harmful drug interactions. The time lag to benefit from the use of many medications used for cardiovascular diseases or their risk factors, such as hypertension and hypercholesterolemia, is frequently longer than the life expectancy of palliative care patients with cancer. It is ethically appropriate to modify, and even to discontinue, cardiovascular pharmacotherapy when there is no prospect of benefit. The decision to discontinue lipid-lowering drugs and antihypertensive drugs is rather straightforward. Antithrombotic therapy may be stopped in low-risk primary prevention but not in high-risk group. Discontinuation of drugs for heart failure may provoke exacerbation of symptoms and should be considered only in the last weeks of life.