Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Bosetti, Cristina; Santucci, Claudia; Pasina, Luca; Fortino, Ida; Merlino, Luca; Corli, Oscar; Nobili, Alessandro

doi:10.1002/pds.5223

Cited by 5 publications

(3 citation statements)

References 35 publications

(78 reference statements)

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“…Furthermore, although the increased use of vitamin D in the older age group of females appears consistent with the risk of osteoporosis, especially if they use corticosteroids, it is not clear how gender medicine can justify the other differences. It could be hypothesized that these medicines are used as placebo, and the appropriateness of prescribing them needs evaluation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

et al. 2021

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Cancer patients are identified as fragile patients who are often immunodepressed and subject to secondary diseases. The Ada cohort comprises cancer survivors aged 15–39 years at diagnosis included in 34 Italian cancer registries. This study aimed to analyze the possible excess of non-cancer medicines use on the basis of the medicine database of the Ada cohort. Records of medicines present in the pharmaceutical flows collected by eight Lombardy cancer registries and used by patients with any type of cancer were extracted for the year 2012. Medicine consumption data were processed to assign a defined daily dose value and to evaluate the consumption of medicines belonging to different groups of the ATC (Anatomical Therapeutic Chemical) classification. The values were compared with values in the Lombardy population. Medicine consumption related to 8150 patients was analyzed, for a total of 632,675 records. ATC groups A and C for females and group N for both sexes showed significant increases. Group J for males and group M for females showed intermediate increases, and group H for both sexes showed smaller increases. This method allowed the identification of excess medicine use to reduce cancer therapy side effects and primary disease sequelae in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

et al. 2021

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“…Data for the present retrospective study derive from the healthcare utilisation databases of Lombardy, a region of Italy with about 10 million residents (ie, about 15% of the Italian population). These databases include information on demographic data of all residents covered by the Regional Health Service, admissions to public or private hospitals, reimbursable drugs dispensed by regional pharmacies or administered directly in healthcare services, disease-specific exemptions, outpatient visits and high-cost drugs 19. Moreover, we also used data of the activity of the CP in Lombardy, available for all private and public hospice and home PC services from Lombardy since 2019 20…”

Section: Methodsmentioning

confidence: 99%

Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study

Chiaruttini

Corli

Pizzuto

et al. 2022

BMJ Support Palliat Care

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ObjectivesHospice and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. Therefore, we aim to investigate the role of palliative care on indicators of end-of-life intensity of care among patients with cancer in Lombardy, the largest Italian region.MethodsWithin a retrospective study using the healthcare utilisation databases of Lombardy, Italy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalisations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits and chemotherapy over a time window of 30 days before death; chemotherapy in the last 14 days was also considered.ResultsOur cohort included 26 539 individuals; of these, 14 320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio (OR) of 0.27 for one hospitalisation, 0.14 for ≥2 hospitalisations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits and 0.66 for chemotherapy use in the last 30 days; the OR was 0.56 for chemotherapy use in the last 14 days.ConclusionsThis large real-world analysis confirms and further support the importance of palliative care assistance for patients with cancer in the end- of- life; this is associated to a significant reduction in unnecessary treatments.

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“…To date, most studies that evaluated changes in the medications in the last year or months of life were conducted in nursing home residents 18–22. Some studies reported on the drug utilisation of older adults in a home care setting,23–25 but no studies focused on drug prescription during the last year or months of life in the setting.…”

Section: Introductionmentioning

confidence: 99%

Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

Hattori

Hamada

Yamanaka

et al. 2022

BMJ Support Palliat Care

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ObjectivesThis study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care.MethodsWe used a nationwide claims database in Japan and selected older adults aged ≥75 years who received home medical care services from ≥12 months before their death. We evaluated medications prescribed 12 months before death (month 12), 3 months before death (month 3) and in the last month of life (month 1). We explored the factors associated with the decreased number of cardiovascular preventive drugs from month 12 to both month 3 and month 1.ResultsA total of 118 661 participants were included, and the majority were aged ≥90 years and women. The prevalence of cardiovascular preventive drugs decreased but remained common in month 1, which included antihypertensives (34.7%), antiplatelets (15.9%), oral anticoagulants (7.6%), antidiabetic drugs (7.3%) and lipid-lowering drugs (6.1%). The relative decrease from month 12 to month 1 was the largest for lipid-lowering drugs (44.8%) and the smallest for oral anticoagulants (13.6%). Among other drugs, laxatives (enema), antiemetics, oral corticosteroids, analgesics, expectorants, bronchodilators and antibiotics showed a large relative increase. Older age, duration of home medical care services for <1 year and diagnoses of cancer, dementia and Parkinson’s disease were associated with a greater likelihood of a decreased number of cardiovascular preventive drugs.ConclusionsThere is room for deprescribing to avoid inappropriate polypharmacy by balancing preventive and symptom management drugs in those receiving home medical care with a limited life expectancy.

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Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Cited by 5 publications

References 35 publications

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study

Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

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