title: Therapeutic futility in cancer patients at the time of palliative care transition: An analysis with a modified version of the Medication Appropriateness Index.
abstract: BACKGROUND
  Palliative Care professionals are often confronted with therapeutic futility, consisting in inappropriate strategies that do not add any advantage to the patient and may actually increase adverse events. Scientific literature concerning this issue is lacking. This article is one of the first to study therapeutic futility specifically at the time of transition to the palliative care setting.
  
  
  OBJECTIVE
  To study the phenomenon of pharmacologic therapeutic futility at the time of transition of a cancer patient to palliative care.
  
  
  METHODS
  The pharmacological prescriptions at the time of the first appointment at an oncological palliative care unit during a time period of 2 months were prospectively collected and characterized using the Medication Appropriateness Index.
  
  
  METHODS
  The sample comprised 71 patients with a mean age of 68.2 years.
  
  
  RESULTS
  The most common pharmacological groups were analgesics (n = 121; 19.2%), psychoactive drugs (n = 89; 14.1%), and antihypertensives (n = 51; 8.1%). A total of 61 patients (85.9%) consumed 5 drugs or more at the time of the first appointment. The mean number of daily medications decreased significantly after the palliative care team intervention, from 7.15 to 5.73 (p < 0.05). The principal causes of inappropriateness were absence of indication for the drug (23.0% "inappropriate"), the drugs' adverse interactions (11.1%), and inadequate dosage (9.9%). After the first consultation in the palliative care setting, 28.2% of the drugs were suspended.
  
  
  CONCLUSIONS
  This article tried to evaluate the main causes of therapeutic futility at the palliative care transition. The principal causes of inappropriateness were absence of clinical indication, clinically significant drug-disease/comorbidity interactions, and incorrect dosage/posology.
authors.affiliation: Medical Oncology Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal p.duarte.domingues@gmail.com.
authors.forename: Duarte
authors.initials: D
authors.lastname: Domingues
authors.affiliation: Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Carneiro
authors.affiliation: Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Costa
authors.affiliation: Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
authors.forename: Carolina
authors.initials: C
authors.lastname: Monteiro
authors.affiliation: Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
authors.forename: Yulyia
authors.initials: Y
authors.lastname: Shvetz
authors.affiliation: Unidade de Saúde Familiar de Vale de Vez, Viana do Castelo, Portugal.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Barbosa
authors.affiliation: Unidade de Saúde Familiar de Vale de Vez, Viana do Castelo, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Azevedo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D000067561:Potentially Inappropriate Medication List; D011446:Prospective Studies
keywords: Medication Appropriateness Index; Therapeutic futility; bioethics; palliative care; palliative care transition