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


CONCLUSIONS
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.
Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. n.raijmakers@erasmusmc.nl
N J H
NJ
Raijmakers
L
L
van Zuylen
C J
CJ
Furst
M
M
Beccaro
L
L
Maiorana
P
P
Pilastri
C
C
Rossi
G
G
Flego
A
A
van der Heide
M
M
Costantini
D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*