Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness
Polypharmacy may be particularly burdensome near the end of life, as patients “accumulate” medications to treat and prevent multiple diseases.
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).
Secondary analysis of baseline data from a trial of statin discontinuation.
Adults with advanced, life-limiting illness.
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.
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.
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 Wordspharmaceutical care quality of life end-of-life care geriatrics
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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