Alwidyan Tahani, Shamieh Omar, Alrjoub Waleed, Alarjeh Ghadeer, Parsons Carole
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Damascus Hwy Road, P.O. Box 330127, Zarqa, 13133, Jordan.
Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan.
Support Care Cancer. 2025 Aug 6;33(9):761. doi: 10.1007/s00520-025-09826-7.
This study evaluated the impact of Palliative Care Consults (PCC) on medicines optimisation in patients with cancer, focusing on deprescribing patterns and associated predictors.
This retrospective cohort study reviewed the medical records of patients with cancer admitted to an inpatient hospice unit between January 1 and December 31, 2022. Data were collected at hospice admission, first PCC assessment, and the day of death. Eligible patients had a life expectancy of ≤ six months, a Palliative Performance Scale (PPS) score ≤ 70%, and were prescribed at least one preventive medication at admission. Outcomes included medication burden (preventive medication use and polypharmacy), symptom control medication use, and potentially inappropriate medication (PIMs) use, assessed using OncPal criteria. PIM deprescribing patterns and predictors of successful deprescribing were analysed.
Among 321 patients (mean age 62.6 years; 60.1% female), the mean number of medications decreased from 7.87 at admission to 7.22 on the day of death (P < 0.001). Preventive medications decreased from 3.53 to 1.25, while symptom control medications increased from 4.34 to 5.98. PCC was associated with a significant PIM reduction (2.11 to 0.52; P < 0.001). Deprescribing was predominantly proactive at the first PCC assessment (61.3%) but reactive in later stages (89.6%). Male gender, absence of polypharmacy, and fewer than three PIMs at admission were significantly associated with successful deprescribing (P < 0.05).
PCC was associated with improved medicines optimisation, though deprescribing remained reactive. Integration of structured, proactive deprescribing guidelines may enhance hospice care at the end of life.
本研究评估了姑息治疗会诊（PCC）对癌症患者药物优化的影响，重点关注撤药模式及相关预测因素。
这项回顾性队列研究回顾了2022年1月1日至12月31日期间入住住院临终关怀病房的癌症患者的病历。在临终关怀入院时、首次PCC评估时以及死亡当天收集数据。符合条件的患者预期寿命≤6个月，姑息治疗表现量表（PPS）评分≤70%，且入院时至少开具了一种预防性药物。结局包括药物负担（预防性药物使用和多重用药）、症状控制药物使用以及潜在不适当药物（PIMs）使用，使用OncPal标准进行评估。分析了PIM撤药模式及成功撤药的预测因素。
在321例患者（平均年龄62.6岁；60.1%为女性）中，药物平均数量从入院时的7.87种降至死亡当天的7.22种（P<0.001）。预防性药物从3.53种降至1.25种，而症状控制药物从4.34种增至5.98种。PCC与PIM显著减少相关（从2.11种降至0.52种；P<0.001）。在首次PCC评估时，撤药主要是主动的（61.3%），但在后期是被动的（89.6%）。男性、不存在多重用药以及入院时PIM少于三种与成功撤药显著相关（P<0.05）。
PCC与改善药物优化相关，尽管撤药仍为被动行为。整合结构化的主动撤药指南可能会改善临终时的临终关怀。
