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.
| Original language | English |
|---|---|
| Pages (from-to) | 1003-1011 |
| Number of pages | 9 |
| Journal | Supportive Care in Cancer |
| Volume | 21 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2013 |
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Keywords
- Drug therapy
- Drug use
- Expert consultation
- Palliative care
- Quality indicator
- Terminal care
ASJC Scopus subject areas
- Oncology
Cite this
Variation in medication use in cancer patients at the end of life : A cross-sectional analysis. / Raijmakers, N. J H; Van Zuylen, L.; Furst, C. J.; Beccaro, M.; Maiorana, L.; Pilastri, P.; Rossi, C.; Flego, G.; Van Der Heide, A.; Costantini, M.
In: Supportive Care in Cancer, Vol. 21, No. 4, 04.2013, p. 1003-1011.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Variation in medication use in cancer patients at the end of life
T2 - A cross-sectional analysis
AU - Raijmakers, N. J H
AU - Van Zuylen, L.
AU - Furst, C. J.
AU - Beccaro, M.
AU - Maiorana, L.
AU - Pilastri, P.
AU - Rossi, C.
AU - Flego, G.
AU - Van Der Heide, A.
AU - Costantini, M.
PY - 2013/4
Y1 - 2013/4
N2 - 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.
AB - 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.
KW - Drug therapy
KW - Drug use
KW - Expert consultation
KW - Palliative care
KW - Quality indicator
KW - Terminal care
UR - http://www.scopus.com/inward/record.url?scp=84879793079&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879793079&partnerID=8YFLogxK
U2 - 10.1007/s00520-012-1619-0
DO - 10.1007/s00520-012-1619-0
M3 - Article
C2 - 23064901
AN - SCOPUS:84879793079
VL - 21
SP - 1003
EP - 1011
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
SN - 0941-4355
IS - 4
ER -