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Variation in medication use in cancer patients at the end of life: a cross-sectional analysis

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Abstract

Purpose

Despite advances in cancer treatment, patients still die with unnecessary suffering. Therefore, high-quality end-of-life care is needed. Variations in medication use at the end of life may suggest areas for improvement. This study aims to describe the use of medications during the last days of life of cancer patients and to explore the possibility of using it as a quality measure.

Methods

We conducted an international survey on experts’ opinions regarding potentially inappropriate medications for dying patients. Subsequently, a chart review of deceased cancer patients was conducted, which assessed the current medication use in different settings.

Results

The mean number of medications used in the last 3 days of life was 4.8 (SD 2.1). Hospital patients were less likely than hospice patients to receive opioids, midazolam, haloperidol, and drugs for pulmonary secretions or nausea/vomiting. Over 90 % of experts rated 12 medications as unlikely to be appropriate. Hospital patients were more likely than hospice patients to receive these potentially inappropriate medications. Before the implementation of an end-of-life care pathway, hospital patients had a higher probability, than after, to receive potentially inappropriate medication. Moreover, after implementation of such pathway, patients for whom a pathway was not used were more likely to receive potentially inappropriate medications than patients for whom it was used.

Conclusion

Medication use at the end of life varies widely by setting, both for potentially appropriate and inappropriate medications. Combining experts’ opinion and current medication use resulted in the identification of 16 medications that might be used to assess the quality of cancer care at the end of life.

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Acknowledgments

This work was supported by the grant from the Italian Minister of Health (Progetto di Ricerca Finalizzata—RFPS-2006-6-341619) and from the Maruzza Lefebvre D’Ovidio Foundation—Onlus, Rome. The sponsors played no role in the conduct of the study, the analysis, as in the preparation of this manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands

    N. J. H. Raijmakers & A. van der Heide

  2. Department of Medical Oncology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands

    N. J. H. Raijmakers & L. van Zuylen

  3. Palliative Care Unit, Stockholms Sjukhem and Karolinska Insitutet, Stockholm, Sweden

    C. J. Furst

  4. Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy

    M. Beccaro, L. Maiorana & M. Costantini

  5. Hospice M. Chighine, Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy

    P. Pilastri

  6. Department of Pneumonology, Villa Scassi Hospital, Genoa, Italy

    C. Rossi

  7. Department of Internal Medicine, Villa Scassi Hospital, Genoa, Italy

    G. Flego

Authors
  1. N. J. H. Raijmakers
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  2. L. van Zuylen
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  3. C. J. Furst
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  4. M. Beccaro
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  5. L. Maiorana
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  7. C. Rossi
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  8. G. Flego
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  9. A. van der Heide
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  10. M. Costantini
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Corresponding author

Correspondence to N. J. H. Raijmakers.

Appendix

Appendix

Table 6 Percentage of experts (N = 16) indicating potential inappropriateness of medication in last three days of life
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Raijmakers, N.J.H., van Zuylen, L., Furst, C.J. et al. Variation in medication use in cancer patients at the end of life: a cross-sectional analysis. Support Care Cancer 21, 1003–1011 (2013). https://doi.org/10.1007/s00520-012-1619-0

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  • DOI: https://doi.org/10.1007/s00520-012-1619-0

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