Brokaar Edwin J, van den Bos Frederiek, Visser Loes E, Portielje Johanneke E A
Department of Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands.
Department of Gerontology & Geriatrics, 4501University Medical Center Leiden, Leiden, the Netherlands.
Am J Hosp Palliat Care. 2022 Jan;39(1):86-100. doi: 10.1177/10499091211003078. Epub 2021 Mar 19.
Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.
多重用药在老年癌症患者中很常见，当因转移性疾病导致预期寿命缩短时，停用潜在不适当的药物就变得非常重要。尤其是预防性药物可能不再有益，因为它们可能会降低生活质量，而且降低发病率和死亡率可能是徒劳的。尽管在生命的最后阶段停用预防性药物很常见，但在晚期疾病的积极癌症治疗期间仍然不常见，尽管在那个阶段预期寿命通常限制在不到1至2年。我们在PubMed和Embase上对常用预防性药物组的停用进行了系统的文献检索，并评估了65岁及以上患有癌症且预期寿命有限（LLE）的患者中潜在益处和危害的证据。从纳入的21项研究中可以得出结论，在相当一部分LLE患者中停用降脂药物、抗高血压药物、骨质疏松药物和降糖药物是可行的。停药可以安全进行，不会发生严重不良事件或降低生存率。唯一一项涉及停药后生活质量的研究表明，停用他汀类药物可改善LLE患者的生活质量。降糖治疗的患者中有0-13%出现需要重新用药的症状复发，使用抗高血压药物的患者中有8-60%出现这种情况。为了减轻用药负担和避免无效治疗，临床医生应与患有晚期癌症且LLE的老年患者讨论停用预防性药物的问题。
