1521P Polypharmacy and therapeutic futility in patients near the end of life

Abstract

The goal for end-of-life cancer patients should be symptom control and improving quality of life through therapeutic optimization and discontinuing futile therapy. However, the maintenance of unneeded drugs is frequent, increasing the risk of harmful drug interactions. The aim of this study was to quantify the number of patients with advanced cancer receiving unnecessary therapies and identify points for improvement in clinical practice. This was a retrospective and observational single-centre study, which included cancer patients that died in the medical oncology unit during a 24 month period. A prognostic score (PaP score) was applied retrospectively. The last chemotherapy (ChT) treatment and drugs prescribed at admission and 24 hours prior to death were analysed and were potentially inappropriate medications (PIMs) were identified. Seventy-four patients were included in the study. On day 1, 89.2% were exposed to at least one PIM, mainly cardiovascular drugs (28.4%), anticoagulants (43.2%), and proton pump inhibitors (74.3%). Twenty-seven patients (36.5%) had a PaP score > 11 (30 day survival probability < 30%). However, there was no significant difference in terms of PIMS in the group with a PaP score > 11 compared to the overall cohort. Therapeutic simplification occurred in 27 patients (36.5%), but PIMs were maintained in 70.3% of patients. Regarding ChT, 34% of patients had ChT in the last two months of life, and 8% in the last two weeks. The prevalence of polypharmacy and PIMs in advanced cancer patients is high. There is a clear need to perform regular prognostic assessments and apply validated prognostic scores to improve clinical practice. Prescriptions must be assessed continuously, aiming to reduce inappropriate drugs, including discontinuation of oncospecific therapy, and favouring symptomatic control and quality of life.