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Journal of General Internal Medicine

, Volume 34, Issue 4, pp 559–566 | Cite as

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

  • Yael SchenkerEmail author
  • Seo Young Park
  • Kwonho Jeong
  • Jennifer Pruskowski
  • Dio Kavalieratos
  • Judith Resick
  • Amy Abernethy
  • Jean S. Kutner
Original Research

Abstract

Background

Polypharmacy may be particularly burdensome near the end of life, as patients “accumulate” medications to treat and prevent multiple diseases.

Objective

To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month–1 year).

Design

Secondary analysis of baseline data from a trial of statin discontinuation.

Participants

Adults with advanced, life-limiting illness.

Main Measures

Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0–90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0–10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.

Key Results

Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient − .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient − .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms.

Conclusions

Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting.

NIH Trial Registry Number

ClinicalTrials.gov Identifier for Parent Study - NCT01415934

Key Words

pharmaceutical care quality of life end-of-life care geriatrics 

Notes

Funding Information

This project is supported by the Palliative Care Research Cooperative Group funded by the National Institute of Nursing Research U24NR014637, by UC4NR12584, and by 5KL2TR1856.

Compliance with Ethical Standards

Conflicts of Interest

Author Amy Abernethy, MD, is an employee of Roche Group/Flatiron Health, has received honoraria from Roche/Genentech in the last 3 years, has stock ownership/options with Athena Health, has a current patent pending for a technology that facilitates the extraction of unstructured information from medical records, and is the owner of Orange Leaf Associates and a senior advisor to Highlander Partners (http://highlander-partners.com/). There are no other conflicts of interest to disclose.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Yael Schenker
    • 1
    Email author
  • Seo Young Park
    • 2
  • Kwonho Jeong
    • 2
  • Jennifer Pruskowski
    • 3
  • Dio Kavalieratos
    • 1
  • Judith Resick
    • 1
  • Amy Abernethy
    • 4
  • Jean S. Kutner
    • 5
  1. 1.Section of Palliative Care and Medical Ethics, Division of General Internal Medicine University of PittsburghPittsburghUSA
  2. 2.Center for Research on Healthcare Data Center, Division of General Internal MedicineUniversity of PittsburghPittsburghUSA
  3. 3.Department of Pharmacy and Therapeutics, UPMC Palliative and Supportive InstituteUniversity of Pittsburgh School of PharmacyPittsburghUSA
  4. 4.Flatiron HealthNYUSA
  5. 5.Division of General Internal Medicine, Department of MedicineUniversity of Colorado School of MedicineAuroraUSA

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