Irish Journal of Medical Science

, Volume 182, Issue 1, pp 107–112 | Cite as

Pharmacological management of co-morbid conditions at the end of life: is less more?

  • S. McLeanEmail author
  • B. Sheehy-Skeffington
  • N. O’Leary
  • A. O’Gorman
Original Article



Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.


The objectives are to determine prescribing practice, for CMCs, in a single SPC service.


Patients referred to a single specialist palliative care (SPC) service, who died between 1/8/2010 and 30/9/2012, were identified. Medical notes were reviewed, and data collected on prescribing at 3 months, 1 month, and 1 week prior to death.


Fifty-two patients with a median age of 74.5 years were identified; 41 patients (79 %) had a malignant condition. 50 % died in hospital. Patients had a mean of three CMCs. A mean of 4.6 medications for CMCs were prescribed to patients over 65. A mean of 10 medications in total were prescribed at 1 week before death. One week before death, one-third of patients continued to be prescribed aspirin, and over one-quarter a statin.


Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice.


Palliative Co-morbid Polypharmacy Prescribing End of life 


Conflict of interest



  1. 1.
    Coebergh JWW, Janssen-Heijnen MLG, Post PN et al (1999) Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of the Netherlands in 1993–1996. J Clin Epidemiology 52(12):1131–1136CrossRefGoogle Scholar
  2. 2.
    Feinstein AR (1985) On classifying cancers while treating patients. Arch Int Med 145:1789–1791CrossRefGoogle Scholar
  3. 3.
    Ryan C, O’Mahony D, Kennedy J et al (2009) Potentially inappropriate prescribing in an Irish elderly population in primary care. B J Clin Pharmacol 68(6):936–947CrossRefGoogle Scholar
  4. 4.
    Walsh EK, Cussen K (2010) “Take ten minutes”: a dedicated ten minute medication review reduces polypharmacy in the elderly. Ir Med J 103(8):236–238PubMedGoogle Scholar
  5. 5.
    Amarenco P, Labreuche J, Lavallee P (2004) Statins in stroke prevention and carotid atheroscelerosis: systematic review and up-to-date meta-analysis. Stroke 35:2902–2909PubMedCrossRefGoogle Scholar
  6. 6.
    Uretsky BF, Young JB, Shahidi FE et al (1993) Randomised study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED investigation group. J Am Coll Cardiol 22(4):955–962PubMedCrossRefGoogle Scholar
  7. 7.
    Stevenson J, Miller C, Abernethy AP et al (2004) Managing comorbidities in patients at the end of life. BMJ 329:909–912PubMedCrossRefGoogle Scholar
  8. 8.
    Silveira MJ, Segnini Kazanis A, Shevrin MP et al (2008) Statins in the last six months of life: a recognizable life-limiting condition does not decrease their use. J Pall Med 11(5):685–693CrossRefGoogle Scholar
  9. 9.
    Sheehy-Skeffington B, McLean S, Bramwell M, O’Leary N, O’Gorman A (in press) Caregivers experiences of managing medications of palliative care patients at the end of life—a qualitative studyGoogle Scholar
  10. 10.
    Garfinkel D, Mangin D (2010) Feasibility study of a systematic approach for discontinuation of multiple medications in older adults. Arch Intern Med 170(18):1648–1654PubMedCrossRefGoogle Scholar
  11. 11.
    Heeschen C, Hamm CW, Laufs U et al (2002) Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation 105:1446–1452PubMedCrossRefGoogle Scholar
  12. 12.
    McGowan MP, for the Treating to New Target Study Group (2004) There is no evidence for an increase in acute coronary syndromes after short-term abrupt discontinuation of statins in stable cardiac patients. Circulation 110:2333–2335PubMedCrossRefGoogle Scholar
  13. 13.
    Arnold EM (1999) The cessation of cancer treatment as a crisis. Soc Work Health Care 29:21–38PubMedCrossRefGoogle Scholar
  14. 14.
    Holmes HM, Cox-Hayley JT, Alexander GC et al (2006) Reconsidering medication appropriateness for patients late in life. Arch Intern Med 166:605–609PubMedCrossRefGoogle Scholar
  15. 15.
    Currow D, Stevenson J, Abernethy A et al (2007) Prescribing in palliative care as death approaches. J Am Geriatr Soc 55:590–595PubMedCrossRefGoogle Scholar
  16. 16.
    Hanlon JT, Schmader KE, Samsa GP et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051PubMedCrossRefGoogle Scholar
  17. 17.
    Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 151:1825–1832PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2012

Authors and Affiliations

  • S. McLean
    • 1
    • 2
    Email author
  • B. Sheehy-Skeffington
    • 1
  • N. O’Leary
    • 1
  • A. O’Gorman
    • 1
  1. 1.Specialist Palliative Care ServiceDochas Centre, Our Lady of Lourdes HospitalDroghedaIreland
  2. 2.St Francis HospiceDublin 5Ireland

Personalised recommendations