Original Article

Supportive Care in Cancer

, Volume 21, Issue 4, pp 1003-1011

First online:

Variation in medication use in cancer patients at the end of life: a cross-sectional analysis

  • N. J. H. RaijmakersAffiliated withDepartment of Public Health, Erasmus MC University Medical CenterDepartment of Medical Oncology, Erasmus MC University Medical Center Email author 
  • , L. van ZuylenAffiliated withDepartment of Medical Oncology, Erasmus MC University Medical Center
  • , C. J. FurstAffiliated withPalliative Care Unit, Stockholms Sjukhem and Karolinska Insitutet
  • , M. BeccaroAffiliated withRegional Palliative Care Network, IRCCS AOU San Martino-IST
  • , L. MaioranaAffiliated withRegional Palliative Care Network, IRCCS AOU San Martino-IST
  • , P. PilastriAffiliated withHospice M. Chighine, Regional Palliative Care Network, IRCCS AOU San Martino-IST
  • , C. RossiAffiliated withDepartment of Pneumonology, Villa Scassi Hospital
  • , G. FlegoAffiliated withDepartment of Internal Medicine, Villa Scassi Hospital
  • , A. van der HeideAffiliated withDepartment of Public Health, Erasmus MC University Medical Center
    • , M. CostantiniAffiliated withRegional Palliative Care Network, IRCCS AOU San Martino-IST

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Abstract

Purpose

Despite advances in cancer treatment, patients still die with unnecessary suffering. Therefore, high-quality end-of-life care is needed. Variations in medication use at the end of life may suggest areas for improvement. This study aims to describe the use of medications during the last days of life of cancer patients and to explore the possibility of using it as a quality measure.

Methods

We conducted an international survey on experts’ opinions regarding potentially inappropriate medications for dying patients. Subsequently, a chart review of deceased cancer patients was conducted, which assessed the current medication use in different settings.

Results

The mean number of medications used in the last 3 days of life was 4.8 (SD 2.1). Hospital patients were less likely than hospice patients to receive opioids, midazolam, haloperidol, and drugs for pulmonary secretions or nausea/vomiting. Over 90 % of experts rated 12 medications as unlikely to be appropriate. Hospital patients were more likely than hospice patients to receive these potentially inappropriate medications. Before the implementation of an end-of-life care pathway, hospital patients had a higher probability, than after, to receive potentially inappropriate medication. Moreover, after implementation of such pathway, patients for whom a pathway was not used were more likely to receive potentially inappropriate medications than patients for whom it was used.

Conclusion

Medication use at the end of life varies widely by setting, both for potentially appropriate and inappropriate medications. Combining experts’ opinion and current medication use resulted in the identification of 16 medications that might be used to assess the quality of cancer care at the end of life.

Keywords

Drug use Drug therapy Expert consultation Palliative care Terminal care Quality indicator