Hedman Christel, Frisk Gabriella, Björkhem-Bergman Linda
Department of Molecular Medicine and Surgery, Karolinska Institutet, Anna Steckséns Gata 53, SE-171 76 Stockholm, Sweden.
R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden.
Life (Basel). 2022 Apr 20;12(5):613. doi: 10.3390/life12050613.
The aim of palliative care is to maintain as high a quality of life (QoL) as possible despite a life-threatening illness. Thus, the prescribed medications need to be evaluated and the benefit of each treatment must be weighed against potential side effects. Medications that contribute to symptom relief and maintained QoL should be prioritized. However, studies have shown that treatment with preventive drugs that may not benefit the patient in end-of-life is generally deprescribed very late in the disease trajectory of cancer patients. Yet, knowing how and when to deprescribe drugs can be difficult. In addition, some drugs, such as beta-blockers, proton pump inhibitors, anti-depressants and cortisone need to be scaled down slowly to avoid troublesome withdrawal symptoms. In contrast, other medicines, such as statins, antihypertensives and vitamins, can be discontinued directly. The aim of this review is to give some advice according to when and how to deprescribe medications in palliative cancer care according to current evidence and clinical praxis. The review includes antihypertensive drugs, statins, anti-coagulants, aspirin, anti-diabetics, proton pump inhibitors, histamin-2-blockers, bisphosphonates denosumab, urologicals, anti-depressants, cortisone, thyroxin and vitamins.
姑息治疗的目的是尽管患有危及生命的疾病，但仍要尽可能维持较高的生活质量（QoL）。因此，需要对所开药物进行评估，并且必须权衡每种治疗的益处与潜在的副作用。应优先考虑有助于缓解症状和维持生活质量的药物。然而，研究表明，对于临终患者可能无益处的预防性药物，在癌症患者的疾病进程中通常很晚才停止使用。然而，了解如何以及何时停用药物可能很困难。此外，一些药物，如β受体阻滞剂、质子泵抑制剂、抗抑郁药和皮质醇，需要缓慢减量以避免出现麻烦的戒断症状。相比之下，其他药物，如他汀类药物、抗高血压药和维生素，可以直接停用。本综述的目的是根据当前证据和临床实践，就姑息性癌症护理中何时以及如何停用药物提供一些建议。该综述包括抗高血压药物、他汀类药物、抗凝剂、阿司匹林、抗糖尿病药物、质子泵抑制剂、组胺-2受体阻滞剂、双膦酸盐、地诺单抗、泌尿系统药物、抗抑郁药、皮质醇、甲状腺素和维生素。
