deprescribing at end of life

My pen poised over the drug chart, I hesitate.

Mr Jones* is a 58-year-old patient that my consultation palliative care team is seeing while he’s in hospital with complications of chemotherapy for advanced lung cancer. I am reviewing his discharge medications before he returns home to the care of the community palliative care team.

He is a very optimistic person, not keen to discuss the possibility of his cancer not getting better. An overweight hypertensive smoker, he’s on a full hand of antihypertensives, anti cholesterol medications, vitamin D supplements, a multi-vitamin, and antiplatelet therapy.

His prognosis is likely less than a year in my mind. Does he need all these medications?

A retrospective cohort study by Todd et al examined this question in groups of people with advanced lung cancer in the United States and the UK. The patients had died and been admitted to hospital then discharged at least once in their last 6 months of life.  Continue reading