Changes in medication use in a cohort of patients with advanced cancer: The international multicentre prospective European Palliative Care Cancer Symptom study

被引:16
作者
Paque, Kristel [1 ,2 ,3 ]
Elseviers, Monique [1 ]
Vander Stichele, Robert [1 ]
Pardon, Koen [2 ,3 ]
Hjermstad, Marianne J. [4 ,5 ]
Kaasa, Stein [4 ,6 ]
Dilles, Tinne [7 ]
De Laat, Martine [8 ]
Van Belle, Simon [2 ,3 ,8 ]
Christiaens, Thierry [1 ]
Deliens, Luc [2 ,3 ,8 ]
机构
[1] Univ Ghent, Heymans Inst Pharmacol, Clin Pharmacol Res Unit, De Pintelaan 185,Blok B 1st Floor, B-9000 Ghent, Belgium
[2] VUB, End Of Life Care Res Grp, Brussels, Belgium
[3] Univ Ghent, Brussels, Belgium
[4] Norwegian Univ Sci & Technol NTNU, Dept Canc Res & Mol Med, European Palliat Care Res Ctr PRC, Fac Med, Trondheim, Norway
[5] Oslo Univ Hosp, Reg Advisory Unit Palliat Care, South Eastern Norway, Oslo, Norway
[6] Trondheim Reg & Univ Hosp, St Olavs Hosp, Canc Clin, Trondheim, Norway
[7] Univ Antwerp, Dept Nursing & Midwifery Sci, CRIC, Fac Med & Hlth Sci, Antwerp, Belgium
[8] Ghent Univ Hosp, Dept Med Oncol, Ghent, Belgium
关键词
Prospective study; drug therapy; neoplasms; palliative care; palliative medicine; deprescriptions; chemotherapy; END-OF-LIFE; MINI-MENTAL-STATE; CLINICAL ONCOLOGY; AMERICAN SOCIETY; DECISION-MAKING; CHEMOTHERAPY; POLYPHARMACY; DISCONTINUATION;
D O I
10.1177/0269216317746843
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Information on medication use in the last months of life is limited. Aim: To describe which medications are prescribed and deprescribed in advanced cancer patients receiving palliative care in relation to time before death and to explore associations with demographic variables. Design: Prospective study, using case report forms for monthly data collection. Medication included cancer treatment and 19 therapeutic groups, grouped into four categories for: (1) cancer therapy, (2) specific cancer-related symptom relief, (3) other symptom relief and (4) long-term prevention. Data were analysed retrospectively using death as the index date. We compared medication use at 5, 4, 3, 2 and 1 month(s) before death by constructing five cross-sectional subsamples with medication use during that month. Paired analyses were done on a subsample of patients with at least two assessments before death. Setting/participants: We studied the medication use of 720 patients (mean age 67, 56% male) in 30 cancer centres representing 12 countries. Results: From 5 to 1 month(s) before death, cancer therapy decreased (55%-24%), most medications for symptom relief increased, for example, opioids (62%-81%) and sedatives (35%-46%), but medication for long-term prevention decreased (38%-27%). The prevalence of chemotherapy was 15.5% in the last month of life, with 9% of new courses started in the last 2 months. With higher age, chemotherapy and opioid use decreased. Conclusion: Medications for symptom relief increased in almost all medication groups. Deprescribing was found in heart medication/anti-hypertensives and cancer therapy, although use of the latter remained relatively high.
引用
收藏
页码:775 / 785
页数:11
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