Injustifiable use of gastroprotection in advanced cancer patients

Abstract

The aim of this survey was to prospectively collect data about gastroprotector prescription at admission of an acute pain relief and palliative care unit. An observational survey was performed on three-hundred consecutive patients. Reasons for admission, concomitant treatment and use of drugs were recorded at admission. About 60.6% patients had been prescribed proton pump inhibitors or anti-H2 receptors agents. Of these patients, possible risk factors were nonsteroidal anti-inflammatory drugs (41, 22.5%), corticosteroids (43, 23.6%), age > 75 years (27, 14.8%). In only 25 admissions (13.7%) prescription corresponded to Italian drug agency recommendations with an odds ratio of an off-label prescription of 7.28. In a relatively high percentage of admissions (55%), patients receiving gastroprotectors were on chemotherapy, with an odds ratio of 1.42. This survey showed that gastroprotectors are often prescribed regardless of Health Care System regulations, as only a minority of patients satisfied the requirements of an appropriate and refundable prescription. The attitudes of oncologists who prescribe gastroprotectors for a putative protective effects are not supported by evidence. Health Care Service in Italy should be aware of these problems to improve the strategies of budgeting the drug expense in a better way or providing further guidelines based on studies able to demonstrate the real cost-benefit ratio of this class of drugs.

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

“…In addition, even for those evaluated in clinical studies (i.e., chemotherapy-induced GERD symptoms or gastroduodenal ulceration), the evidence is low and often derives from single studies or single centers. Nevertheless, up to 73 % of patients admitted to oncology or hematology units are treated with acid suppressants (PPIs or H 2 RAs) [341, 342], mostly for SUP or unspecified gastroprotection.…”

Is there overuse of proton pump inhibitors in B‐cell non‐Hodgkin lymphomas? A cohort study based on the French health insurance database in the Midi‐Pyrénées region

“…Among the 715 patients who were nonusers of PPIs during the year before B‐NHL diagnosis, 350 (48.9%; CI: 45.2–52.6) had at least one PPIs reimbursement during the active treatment phase of B‐NHL. The median period between PPIs initiation and cancer diagnosis was 7 weeks. Omeprazole was the most frequently used PPIs ( n = 214, 46.1%), followed by esomeprazole ( n = 145, 31.5%), pantoprazole ( n = 44, 9.5%), rabeprazole ( n = 31, 6.7%) and lansoprazole ( n = 29, 6.2%).…”

“…The median duration of treatment was 65.3 days . The median number of dispensation of PPIs per patient was 6 [4][5][6][7][8]. The median number of distinct PPIs dispensed per patient was 1 [1,2].…”

“…Polypharmacy is frequent in oncology because of the characteristics of the population and the need to treat adverse outcomes of both the disease and its treatment. Proton pump inhibitors (PPIs) are widely used in this context, with a prevalence of exposure varying between 20 and 60% . PPIs are indicated to treat peptic ulcers, gastrooesophageal reflux disease and oesophagitis for periods ranging from 7 days to 4–8 weeks.…”

Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer

“…Prophylactic proton pump inhibitors or histamine H2 receptor antagonists are often prescribed regardless of guidelines suggesting otherwise. 62 Peptic ulcer was shown to be a rare complication of corticosteroid therapy in a meta-analysis of all RCTs in which steroids had been administered. 53 Subsequent reviews have reported an incidence of gastrointestinal complications of less than 8%.…”