Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Schenker, Yael; Park, Seo Young; Jeong, Kwonho; Pruskowski, Jennifer; Kavalieratos, Dio; Resick, Judith; Abernethy, Amy Pickar; Kutner, Jean S.

doi:10.1007/s11606-019-04837-7

Cited by 88 publications

(71 citation statements)

References 31 publications

(34 reference statements)

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“…Over the next several decades, it is anticipated that primary care teams will experience more pressure to deliver care to those who are dying, as the patients with complex care needs will continue to rise and increasingly more people will die in the community settings. [23] Our data together with these projected trends and people's preferences to be cared for in the community [3] [27] Our data support these findings and prompt actions to address the gaps in primary care providers.…”

Section: Main Findings and Implicationssupporting

confidence: 58%

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Gao

Gulliford

Morgan

et al. 2020

Preprint

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Background End of life(EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice(GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data(the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations(primary), number of prescriptions and referral to other care services(yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio(aRR). Results Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations(Standard deviation(SD): 31.7; total=3,031,734), 71.5 prescriptions(SD: 68.0; total=5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral(aRRs 1.07-2.03). Increasing age was related to fewer consultations(aRRs 0.77-0.96), less prescriptions(aRR 1.09-1.44), and a higher chance of referral(aRRs 1.08-1.16) but less likely to have palliative care needs recognised(aRRs 0.53-0.89). Conclusions GPs are very involved in end of life care of cancer patients, most of whom having complex care needs, i.e. older age, comorbidity and polypharmacy. This highlights the importance of enhancing primary palliative care skills among GPs and the imperative of greater integration of primary care with other healthcare professionals including oncologists, palliative care specialists, geriatricians and pharmacists. Research into the potential of deprescribing is warranted. Older patients have poorer access to both primary care and palliative care need to be addressed in future practices.

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Section: Main Findings and Implicationssupporting

confidence: 58%

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Gao

Gulliford

Morgan

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Polypharmacy around the end of life may also involve inappropriate prescribing, a previous study estimated that this proportion may be as high as one third among centanarians [30]. Polypharmacy has been shown to increase the symptom burden, the risk of adverse drug effects and even mortality [31], future research should be directed to safe and effective deprescribing for end of life care patients. Tools like the Drug Burden Index [32], which measures cumulative exposure to anticholinergic and sedative drugs or other measures of anticholinergic burden, may help guide drug choices at the end of life.…”

Section: Main Findings and Implicationsmentioning

confidence: 99%

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

et al. 2020

View full text Add to dashboard Cite

Background: End of life (EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice (GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods: A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data (the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations (primary), number of prescriptions and referral to other care services (yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio (aRR). Results: Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations (Standard deviation (SD): 31.7; total = 3,031,734), 71.5 prescriptions (SD: 68.0; total = 5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral (aRRs 1.07-2.03). Increasing age was related to fewer consultations (aRRs 0.77-0.96), less prescriptions (aRR 1.09-1.44), and a higher chance of referral (aRRs 1.08-1.16) but less likely to have palliative care needs recognised (aRRs 0.53-0.89).

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“…Furthermore, the use of multiple drugs can increase pill burden and medical costs 3 . Concurrently, the prescription of multiple medications may negatively affect patient adherence and health-related quality of life (HRQOL) 8 . Older individuals are particularly vulnerable to unexpected drug-related problems because of the multiple drug regimens, higher number of comorbid conditions, and age-associated physiological changes in pharmacokinetics and pharmacodynamics with respect to certain drugs 5 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study

Chang

Park

Kim

et al. 2020

Sci Rep

128

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Polypharmacy is a growing and major public health issue, particularly in the geriatric population. This study aimed to examine the association between polypharmacy and the risk of hospitalization and mortality. We included 3,007,620 elderly individuals aged ≥ 65 years who had at least one routinely-prescribed medication but had no prior hospitalization within a year. The primary exposures of interest were number of daily prescribed medications (1–2, 3–4, 5–6, 7–8, 9–10, and ≥ 11) and presence of polypharmacy (≥ 5 prescription drugs per day). The corresponding comparators were the lowest number of medications (1–2) and absence of polypharmacy. The study outcomes were hospitalization and all-cause death. The median age of participants was 72 years and 39.5% were men. Approximately, 46.6% of participants experienced polypharmacy. Over a median follow-up of 5.0 years, 2,028,062 (67.4%) hospitalizations and 459,076 (15.3%) all-cause deaths were observed. An incrementally higher number of daily prescribed medications was found to be associated with increasingly higher risk for hospitalization and mortality. These associations were consistent across subgroups of age, sex, residential area, and comorbidities. Furthermore, polypharmacy was associated with greater risk of hospitalization and death: adjusted HRs (95% CIs) were 1.18 (1.18–1.19) and 1.25 (1.24–1.25) in the overall and 1.16 (1.16–1.17) and 1.25 (1.24–1.25) in the matched cohorts, respectively. Hence, polypharmacy was associated with a higher risk of hospitalization and all-cause death among elderly individuals.

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Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Cited by 88 publications

References 31 publications

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study

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