Inappropriate medication use and polypharmacy in end‐stage cancer patients: Isn't it the family doctor's role to de‐prescribe much earlier?

Summary Background Elderly patients are exposed to increased number of medications, often with no proof of a positive benefit/risk ratio. Unfortunately, this trend does not spare those with limited life expectancy, including end‐stage cancer patients who require only palliative treatment. For many medications in this subpopulation, the risk of adverse drug events outweighs the possible benefits and yet, many are still poly‐medicated during their last year of life. Aim To describe the extent of polypharmacy among end‐stage cancer patients, at the time of admission to homecare hospice. Methods A retrospective chart review of 202 patients admitted to Homecare Hospice of the Israel Cancer Association and died before January 2015. Results Average lifespan from admission until death was 39.2 ± 5.4 days. 63% died within the first month, 89% within 3 months. Excluding oncological treatments, 181 (90%) and 46 (23%) patients were treated with ≥ 6 and ≥ 12 drugs for chronic diseases, respectively. Two months before death, 32 (16%) patients were treated with ≥ 3 blood pressure lowering drugs, 62 (31%) with statins and 48 (23%) with aspirin. Conclusion Though not representative of the whole end‐stage cancer patient population, our study demonstrates that these patients are exposed to extensive polypharmacy. Most of these medications could have probably been safely de‐prescribed much earlier in the course of the malignant disease. Considering the prolonged trust‐based relationship with their patients, the family physicians are those who should be encouraged to implement the palliative approach and reduce polypharmacy much before reaching hospice settings.