Potentially Inappropriate Prescriptionss in End-of-Life Cancer Patients in Home-Based Hospice Care.

Abstract

Context: Polypharmacy and inappropriate prescribing are prevalent among end-of-life cancer patients, potentially compromising symptom management and quality of life. Limited data are available on potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) of opioid in South Korea, particularly in home-based hospice care settings.

Objectives: This study aimed to evaluate the prevalence of PIMs and PPOs in advanced cancer patients referred to home-based hospice care and identify factors associated with these prescribing issues.

Methods: A retrospective observational study included 102 advanced cancer patients referred to a single center's home-based hospice care between November 2022 and November 2023. PIMs were assessed using the STOPPFrail criteria, while PPOs were defined as inadequate opioid prescribing omissions for moderate to severe cancer pain. Logistic regression analysis identified factors associated with PIMs and PPOs.

Results: PIMs were observed in 40.2% of patients, with higher prevalence in those over 70 years old (48.7%) and those with multiple comorbidities. Statins (25.5%) and antihypertensives (29.4%) were the most common PIMs. Among patients with moderate to severe cancer pain, 45.5% experienced PPOs due to inadequate opioid prescriptions. Older age (OR 3.90, p < 0.01) and comorbidities (OR 20.90, p < 0.01) were significantly associated with PIMs, while diabetes was linked to PPOs (OR 2.00, p = 0.01).

Conclusion: The findings highlight critical gaps in medication management for end-of-life cancer patients. Systematic deprescribing protocols and improved strategies to address opioid stigma and prescribing hesitancy are essential to align treatments with end-of-life care goals and enhance patient quality of life.