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Deprescribing in Older Adults With Cancer and Limited Life Expectancy: An Integrative Review
- Source :
- American Journal of Hospice and Palliative Medicine. SAGE PUBLICATIONS INC, American Journal of Hospice and Palliative Medicine, American Journal of Hospice and Palliative Medicine, 39(1), 86-100. SAGE Publishing
- Publication Year :
- 2021
- Publisher :
- SAGE Publications, 2021.
-
Abstract
- Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.
- Subjects :
- medicine.medical_specialty
Osteoporosis
Inappropriate Prescribing
Disease
03 medical and health sciences
Deprescriptions
Life Expectancy
0302 clinical medicine
SDG 3 - Good Health and Well-being
deprescribing
Quality of life
Neoplasms
medicine
Humans
advanced cancer
030212 general & internal medicine
Adverse effect
Intensive care medicine
Aged
Polypharmacy
older adults with cancer
medication discontinuation
business.industry
limited life expectancy
General Medicine
medicine.disease
Discontinuation
030220 oncology & carcinogenesis
Quality of Life
Life expectancy
Deprescribing
business
Subjects
Details
- ISSN :
- 19382715 and 10499091
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- American Journal of Hospice and Palliative Medicine®
- Accession number :
- edsair.doi.dedup.....2b1971ccb8b79048966bc0c39c964e7c