Polypharmacy And The Use Of Low Or Limited Value Medications In Advanced Cancer.

BACKGROUND Patients with advanced malignancy are often on medications for co-morbidities, including those for primary or secondary prevention. The benefit from these medications can be limited and may result in adverse effects, interact with medications used for the malignancy or associated symptoms, increase pill burden and reduce quality of life. METHODS A retrospective chart review was conducted of patients with incurable malignancy admitted under medical oncology at Liverpool Hospital over a 90-day period. Demographic variables, co-morbidities, disease related parameters and medications were reviewed. Criteria were established to identify low or limited value medications. RESULTS Seventy-eight patients were identified between September and December 2018. Thirty day mortality was 33%. Sixty five percent of the cohort were on 5 or more medications and 24% on 10 or more. One low or limited value medication was reported in 36% and 20% were on 2 or more. Age ≤ 60 years was associated with a risk of being on at least one unnecessary medication. Patients with fewer co-morbidities and those in their last three months of life were significantly less likely to have polypharmacy. Nine percent of the cohort was on 3 or more antihypertensives and 6% of patients were on 3 or more oral hypoglycemics. CONCLUSION Polypharmacy and continued prescribing of low or limited value medications was identified in a high proportion of patients. Further studies are needed to assess the impact of continuing these medications, as well as investigation of patient and physician attitudes towards de-escalation. This article is protected by copyright. All rights reserved.