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Analysis of the medical records of 1,269 elderly patients with advanced cancer by researchers at University of Tsukuba has found that more than 70% were prescribed potentially inappropriate medications (PIMs) and that the prescription rate declined closer to the patient's death. Discontinuation was more frequent among patients admitted to palliative care units, those with polypharmacy, and females. These findings may help reduce treatment burden among patients nearing the end of their life.

Tsukuba, Japan—Analysis of the medical records of 1,269 elderly patients with advanced cancer by researchers at the University of Tsukuba has found that more than 70% were prescribed potentially inappropriate medications (PIMs) and that the prescription rate declined closer to the patient's death. Discontinuation was more frequent among patients admitted to palliative care units, those with polypharmacy, and females. These findings may help reduce treatment burden among patients nearing the end of their life.

Many older adults with advanced cancer are prescribed multiple medications—these may be for cancer-related symptoms or chronic conditions such as hypertension and diabetes. However, as patients near the end of their life, some medications may cause more harm than benefit. These drugs, which are known as potentially inappropriate medications (PIMs), should be considered for deprescribing because they may worsen the patient's condition or increase treatment burden. However, it is scarcely known about how frequent PIMs are prescribed in Japanese healthcare settings and which patients are most possibly to have these medications discontinued. To address this gap, the research team examined real-world patterns of PIM usage and factors associated with deprescribing in elderly patients with advanced cancer who are approaching the end of their life.

The study analyzed medical claims data from 1,269 patients aged ≥65 years who died of cancer in Mito City, Ibaraki Prefecture. Prescription data were reviewed at three time points—6 months, 3 months, and 1 month before death—using the OncPal Deprescribing Guideline to identify PIMs.

Two key findings emerged:
(1) Trends in PIM use: Approximately 77% of patients were prescribed at least one PIM 6 months before death which decreased to 70% within 1 month before death, suggesting gradual medication consolidation toward the end of life.
(2) Factors associated with deprescribing: Discontinuation was more likely among female patients, patients with a higher number of medications and comorbidities, and patients admitted to hospitals—particularly palliative care units.

These results highlight that, although PIM usage declines over time, more than 70% of patients still receive such medications, indicating that there is a room for further improvement. Developing structured programs to promote appropriate deprescribing could minimize unnecessary harm and optimize care for patients nearing the end of their life.

Original Paper

Title of original paper:

Trends in prescriptions and factors associated with discontinuation of potentially inappropriate medications in elderly patients with advanced cancer at the end of life: A retrospective cohort study

Journal:

Palliative Care and Social Practice

DOI:

10.1177/26323524251403020

Correspondence

Assistant Professor MASUMOTO Shoichi
Institute of Medicine, University of Tsukuba

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Institute of Medicine