April 01, 2019
By Reuters Staff
NEW YORK (Reuters Health) - Many preventive drugs could be safely discontinued, with substantial cost savings, in the last year of life of older adults with cancer, according to a retrospective study of Swedish data.
Earlier observational studies have cast doubt on the benefit of preventive medications prescribed during the last year of life among patients with life-limiting disease.
Lucas Morin from Karolinska Institutet, in Stockholm, and colleagues used data from adults age 65 years and older who died with cancer in Sweden between 2007 and 2013 to evaluate the prescribing of preventive drugs throughout the final year of life and to estimate the direct costs of preventive drugs.
Among more than 151,000 older adults included in the study, the mean age at the time of death was 81.3 years, and most patients had been diagnosed with cancer >12 months (60%) or between six and 12 months (12%) before death.
During the last year of life, the mean number of prescribed drugs increased from 6.9 to 10.1 per person, and the percentage of individuals using at least 10 drugs rose from 26% to 52%, the researchers report in Cancer, online March 25.
Even in the last month of life, 60.1% of people were receiving antihypertensives, 16.8% were receiving lipid-modifying agents, 48.1% were receiving antithrombotic agents, 19.2% were receiving mineral supplements and 9.2% were receiving vitamins. Other commonly prescribed drugs included those used in diabetes (14.9%), antianemic preparations (30.4%), and bisphosphonates (3.9%).
The median drug cost during the last year of life was $1,482 per person, and the median monthly drug costs increased from $80 to $153 over the course of the last year of life.
The median cost for preventive drugs during the last year of life was $213, with significant variation across cancer types. The percentage of total drug costs corresponding to preventive drugs was 20.2% during the last year of life, with a small decrease from 20.5% during the 12 months before death to 18.5% during the last month before death.
Costs due to preventive drugs were highest among older adults aged <80 years and among those with at least five chronic comorbidities, although women with breast cancer had significantly higher costs for preventive drugs despite a low burden of chronic multimorbidity.
"In this context, the use of preventive drugs should be reconsidered in light of the patient's goals of care, values, and preferences," the researchers conclude. "Reducing the therapeutic burden in individuals with advanced cancer has the potential to not only reduce unnecessary adverse effects and improve patient quality of life, but also to reduce the financial burden for patients."
Morin did not respond to a request for comments.
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