Analysis Reveals Polypharmacy Challenges in Patients With Cancer

The March 2025 issue of Supportive Care in Cancer published study results that show cancer patients receiving palliative care take an average of 2 unneeded medications.¹ A team of researchers from Ireland investigated this issue prospectively with medication reconciliation. They found unnecessary vitamin, gastroesophageal reflux disease (GERD), and lipid-lowering prescriptions.¹

Patients in palliative care often still receive medications | Image credit: Kenishirotie | stock.adobe.com

Although most health care professionals agree that patients do not need prescriptions for chronic diseases during end-of-life care, patients often receive them anyway. This contributes to pill burden, as well as potential drug adverse effects or drug interactions. Older adult patients have slower drug excretion rates via the kidney or liver than younger adults, and ultimately patients’ quality of life suffers.

Although practitioners have some guidelines to help them deprescribe, the researchers noted that there is not sufficient prospective evidence to support a single guideline. ^1-3 To correct this issue, a 2014-2015 study used a deprescribing guideline known as OncPal.¹ The Irish researchers indicated the existing studies were only observational studies and said they wished to use this research to validate the guideline and alleviate their patients’ pill burdens.¹ The 48 patients studied had a median age of 70.¹

In the study, physicians agreed with pharmacists to cancel a prescription 7 out of 10 times on average.¹ If a patient had GERD, the physician kept this medication 73% of the time. All other medications were kept 21% of the time. Physicians and patients felt the GERD pain reduction outweighed fracture, osteoporosis, and C. difficile infection risk.¹

Pharmacists speaking to a physician had a 72% success rate of persuading a physician to discontinue a medication. In contrast, when pharmacists placed a recommendation in writing, the pharmacists had a 70% success rate in the physician discontinuing the medication.¹ The researchers believe that how a pharmacist interacted with the physician played a role. Was there trust and rapport between the pharmacist and the prescriber? If so, that carries more weight.

Stopping medications created per-patient savings of almost 20 euros (the currency in Ireland, which in 2024 US dollars is $21.91).¹ Additionally, time savings for staff by not administering prescriptions was 41 to 179 minutes.¹ The researchers suggested nursing staff would have more time to spend educating patients or relatives about an illness.¹

Guidelines are expected to change. Currently, OncPal does not classify antithrombotic medicine as inappropriate. In the future, OncPal will classify antithrombotic medicine as inappropriate in patients choosing palliative care because the risk of thrombosis in cancer patients on palliative care is outweighed by the harm of bleeding.¹

Palliative care focuses on quality of life and pain minimization, and medication-induced adverse effects need to be minimized by limiting drugs. Notably, the findings suggest that face-to-face communication may have a slightly better success rate for pharmacists when possible. ¹

REFERENCES

1. McAdam C, O’Dwyer E, Dalton K. Pharmacist-led deprescribing interventions for cancer patients in a specialist palliative care setting. Suppprt Care Cancer. 2025;33(321). doi:10.1007/s00520-025-09341-9

2. Lindsay J, Dooley M, Martin J, et al. The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline’. Support Care Cancer. 2015;23(1):71-78. doi:10.1007/s00520-014-2322-0

3. McNeill R, Hanger HC, Chieng J, Chin P. Polypharmacy in palliative care: two deprescribing tools compared with a clinical review. J Palliat Med. 2021;24(5):661-667. doi:10.1089/jpm.2020.0225