title: Polypharmacy in the terminal stage of cancer.
abstract: OBJECTIVE
  This study aims to determine the numbers of patients with advanced cancer receiving polypharmacy at the end of their lives and analyze differences in drug prescription at a general oncology ward and a dedicated palliative care ward.
  
  
  METHODS
  A retrospective single-center cohort study at a university hospital with a large cancer center was conducted. The charts of 100 patients who had died because of advanced cancer were reviewed; data concerning sociodemographic variables and medications were collected at four predefined time points (9, 6, 3, 0 days before death).
  
  
  RESULTS
  Nine days before death, polypharmacy was registered in 95 % of patients; they had prescriptions for 11 (9-13) different medications per day (median, IQR). Although this number dropped significantly, on the last day as many as 61 % of the patients were still taking more than 4 drugs (median 6.5, IQR 4-9). No significant difference was noted between the oncology ward and the palliative care ward. Polypharmacy was largely dependent on the patients' ECOG performance status as well as the type of ward, the number of days before death, and age. It was not influenced by gender, the duration of hospital stays, and the devices facilitating drug administration. The medications fulfilled the requirements of palliative care in the majority of patients; 90 % received treatment for pain and anxiety. Patients treated at the palliative ward received more opioids and psychoactive drugs while those at the oncology ward received more anti-cancer drugs and fluids.
  
  
  CONCLUSIONS
  Polypharmacy still is a problem in the large majority of patients with terminal cancer. Further studies should be focused on the patients' quality of life, drug interactions, and adverse events.
authors.affiliation: Unit of Palliative Care, Department of Internal Medicine I, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria. katharina.kierner@meduniwien.ac.at.
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Kierner
authors.affiliation: Department of Anesthesiology, Head of Palliative Care Team, Horn Hospital, Horn, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Weixler
authors.affiliation: Unit of Palliative Care, Department of Internal Medicine I, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
authors.forename: Eva K
authors.initials: EK
authors.lastname: Masel
authors.affiliation: Unit of Palliative Care, Department of Internal Medicine I, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
authors.forename: Verena
authors.initials: V
authors.lastname: Gartner
authors.affiliation: Unit of Palliative Care, Department of Internal Medicine I, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Watzke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D010166:Palliative Care; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents
keywords: Advanced cancer; End of life; Palliative care; Polypharmacy