Abstract
ObjectivesTo develop criteria for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults (≥65 years) with cancer who are receiving palliative care and have an estimated life expectancy of <1 year. Materials and methodsA two-round Delphi exercise was conducted using web-based questionnaires. A panel of 18 expert stakeholders with expertise in palliative care, oncology and/or geriatric medicine across Ireland and the United Kingdom rated their level of agreement with each statement using a 5-point Likert scale and had the option of adding free-text comments throughout the questionnaire. A priori decision rules were used to accept or reject criteria. ResultsTwenty-eight criteria were presented in Round 1. Group consensus was achieved for 15 criteria which were included in the final set of criteria. Following a review of the panel's ratings and additional comments for the remaining 13 criteria, four criteria were removed from Round 2. Group consensus was achieved for all nine criteria included in Round 2. The final set comprised 24 criteria relating to: anorexia-cachexia (n = 1); anxiety (n = 2); constipation (n = 5); delirium (n = 1); depression (n = 3); diarrhoea (n = 1); dyspnoea/breathlessness (n = 1); fatigue (n = 2); insomnia (n = 2); nausea and vomiting (n = 2); pain (n = 3); duplicate drug classes (n = 1). ConclusionA consensus-agreed set of prescribing criteria has been developed for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults with cancer who are receiving palliative care and have an estimated life expectancy of less than one year. Future studies should examine the application and validity of these criteria.
Highlights
The global burden of cancer is increasing, partly driven by population ageing, and by 2038, it is expected that more than half of all new cancer diagnoses will occur in older adults (≥65 years) [1]
The PIP-CPC criteria consist of 24 criteria for the treatment of symptoms listed in the European Association for Palliative Care's dataset for describing a palliative care cancer population [27]
Corticosteroids should be limited to short-term use (≤4 weeks total treatment including weaning period; with administration of a maintenance dose as low as possible if the patients' symptoms deteriorate during weaning) for the treatment of anorexia-cachexia, unless there is a marked decrease in appetite following discontinuation
Summary
The global burden of cancer is increasing, partly driven by population ageing, and by 2038, it is expected that more than half of all new cancer diagnoses will occur in older adults (≥65 years) [1]. Populationbased studies have reported that the estimated prevalence of multimorbidity (two or more chronic conditions) in this patient cohort varies according to cancer type with higher prevalence rates amongst older age groups [2,3]. These pre-existing health conditions can necessitate the use of polypharmacy, which is commonly defined as the prescribing of five or more medications [3,4,5]. For those who subsequently engage with palliative care services, the number of medications prescribed often increases between referral and death due to the continuation of medications for co-morbid conditions and the addition of medications for symptomatic relief (e.g. analgesics, laxatives) [8,9]
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