From jorono [Image], 2018, https://pixabay.com/photos/stop-drug-addiction-3541701/. Pixabay CC BY 2.0
Background: Patients referred for hospice often have multiple co-morbidities and can be at risk of polypharmacy, especially as they become frailer as they approach the end of life. Ongoing treatment of chronic conditions such as hypertension and hyperlipidemia can pose more risk than benefit in this population. There is a need to assess continuation of potentially inappropriate medications (PIMs) in the home hospice population. Additionally, it is important to consider if patients are receiving needed medications to treat cancer-related pain.
Design and Participants: This study was a single-center retrospective observational study looking at patients with cancer referred to home hospice services between 11/2022-11/2023 in South Korea. They utilized the Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy (STOPPFrail) deprescribing tool to evaluate medications and potential for PIMs. They also looked like a potential prescribing omission (PPO), most focused on availability of opioid medications for patients with moderate to severe cancer-related pain. World Health Organization (WHO) guidelines recommend opioids to treat significant cancer-related pain.
Results: The study included a total of 102 patients with cancer who were referred for home hospice services during the study period. The majority (76.5%) were over 70 years old. Study group had slightly more male participants (56.9%). The most common cancer diagnosis was lung cancer (22.6%). Comorbidities were more commonly noted in the older patients (>70 years old). Overall prevalence of comorbidities was as follows: hypertension (51%), diabetes (27.5%), and dyslipidemia (27.5%). Of the total study group, 40.2% had potentially inappropriate medications (PIM) identified, more often with patients over 70 years old. The most common PIM identified were statins (25.5%) and antihypertensives (29.4%) and antidiabetics (22.6%) and antiplatelets (15.7%).
Most patients in the study group (64.7%) reported cancer pain and almost half (45.5%) of patients reporting moderate to severe cancer pain did not receive or have opioids prescribed. Of note, reporting of cancer pain was more common among younger patients (<70 yrs old) with a total of 59% of older patients' vs 83.3% of younger patients reporting cancer pain.
Commentary: The study focuses on the need for deprescribing PIMs as patients with advanced cancer transition to a comfort focused care plan with hospice at home. They also highlight the need for adequate treatment of cancer-related pain in patients on hospice at home. This study was conducted in South Korea, and it is unclear how translatable the results would be to the U.S. hospice population. I suspect that there is a similar need for deprescribing in hospice patients with advanced cancer in the U.S.
Bottom Line: The study highlights the need to examine the appropriateness of medications for patients with advanced cancer on home hospice. The focus was on deprescribing potentially inappropriate medications and ensuring that patients have appropriate medications for cancer-related pain. It was conducted in South Korea over a 1-year period.
Source: Lee J, Lee CW, Kim HS, Kim, HR, Lim SY, Kim JR. Potentially Inappropriate Prescriptions in End-of Life Cancer Patients in Home-Based Hospice Care. J Pain Symptom Management. 2025-07, Vol. 70 (1), p. 22-29. DOI: 10.1016/j.jpainsymman.2025.03.021
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