Abstract
Statin treatment is often terminated in patients with advanced cancer but guidelines for statin discontinuation are still lacking. The aim of this study was to investigate sex-differences in time-points of statin discontinuation in patients with advanced cancer. Medical records from 1535 deceased patients enrolled at a Palliative Home Care Unit were reviewed. A total of 149 patients (42 women and 107 men) who were diagnosed with cancer, and were treated with statins one year before death, were identified. Statin treatment was terminated earlier in women than in men, 3.0 months prior to death (IQR 0.88–7.25) as compared to 1.5 months (IQR 0.5–4.0) (p < 0.05), respectively. In a longitudinal analysis there was a significant difference between men and women still on statin treatment at all studied time-points, 9, 6, and 3 months before death (p < 0.05), where women terminated statin treatment earlier in the disease trajectory. Baseline demographics were similar between the sexes except that more men than women had a history of previous cardiovascular events (p < 0.01). However, neither the indication for statin treatment, i.e., primary prevention versus secondary prevention, nor age could explain the sex-difference in statin discontinuation. There was no difference in cardiovascular events or mortality between men and women after statin discontinuation.
Highlights
Preventive medications to lower cholesterol and blood pressure can often be discontinued in patients with advanced cancer since they are considered to do more harm than good
In a small pilot-study (n = 52) from a palliative unit in Stockholm, Sweden, we previously reported that statin treatment was terminated significantly earlier in women than in men [18]
More men than women had a history of previous myocardial infarction (p < 0.05), and the indication for statin treatment was more often secondary prevention among men than among women (p < 0.01)
Summary
Preventive medications to lower cholesterol and blood pressure can often be discontinued in patients with advanced cancer since they are considered to do more harm than good. Studies show that such medications are generally discontinued very late in the disease trajectory [1,2,3,4]. This may be due to patient perception of deprescribing, to the physician’s opinion on the effects of statins in the elderly or to physician fear of causing harm to the patient [5,6,7]. There are so far no guidelines based on randomized controlled trials to support physician and patients in the decision to terminate statins in palliative cancer patients [8,9]. The consensus was based on criteria from the Screening Tool of Older Persons’ Potentially Inappropriate
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