Abstract
PurposePalliative cancer patients can benefit from deprescribing of potentially inappropriate medications (PIMs). Tools and guidelines developed for the geriatric population are mainly available. This systematic review gives an overview of available guidelines and tools to deprescribe for palliative cancer patients.MethodsA systematic search was carried out using the databases SCOPUS and PubMed. Studies focused on palliative cancer patients were included.ResultsThe search identified 137 studies of which 15 studies were included in this systematic review. Six of the included tools were developed specifically for cancer patients. One of these tools was externally validated and applied in several studies and settings. Guidelines or tools that were not specifically developed for cancer patients but that were applied on cohorts of palliative cancer patients were also included.ConclusionTools developed for geriatric patients contain drugs that are not inappropriate when used in the palliative cancer care setting. Tools developed for cancer patients are more suitable and can be applied in combination with stepwise methods to individualize deprescribing per patient. The tools and guidelines described in this systematic review can be used to further implement deprescribing in the clinical routine for palliative cancer patients.
Highlights
The use of a multitude of drugs is often termed “polypharmacy.” In general, most practitioners understand this term in a negative connotation, when patients are taking a relatively large number of different drugs, and/or a number of drugs for which the appropriateness may be questionable (potentially inappropriate medications (PIMs))
Six deprescribing tools or guidelines for cancer patients and three deprescribing tools or guidelines not designed for cancer patients were identified
To implement the concept of deprescribing in routine clinical care of palliative cancer patients, guidelines or consensus statements will be of great value
Summary
The use of a multitude of drugs is often termed “polypharmacy.” In general, most practitioners understand this term in a negative connotation, when patients are taking a relatively large number of different drugs, and/or a number of drugs for which the appropriateness may be questionable (potentially inappropriate medications (PIMs)). The concept of deprescribing, to reduce polypharmacy and/or the number of PIMs in patients, was defined by Scott et al as: “a systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patients’ goals, current level of functioning, life expectancy, values and preferences” [1] This concept serves multiple aims, for it has been shown that reducing the pill burden of patients with a limited life expectancy can increase quality of life [2, 5], decrease the risk of side effects or worse clinical outcome [6, 7], and reduce healthcare costs [3, 8, 9]. We will summarize and compare the available options that have been published in the scientific literature
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