Patients with Advanced Lung Cancer Receive Unnecessary Medicine at Hospital Discharge

The number of preventative medicines that patients with advanced lung cancer receive upon hospital admission may reflect the increased amount they are given at discharge, according to study results published in British Journal of Clinical Pharmacology.

In turn, the researchers highlighted the need for physicians to reduce the amount of preventative medication prescribed at discharge that can be burdensome and no longer appropriate given the reduced life expectancy associated with advanced disease.

Most patients with lung cancer present with comorbidities such as cardiovascular disease, cerebrovascular disease and chronic obstructive pulmonary disease (COPD).

“The presence of these chronic conditions is accompanied by the chronic use of medications to maintain disease control or to treat symptoms associated with these conditions or to prevent further worsening of them,” the researchers wrote.

Because of this, polypharmacy — or the concurrent use of multiple medications by a patient – is common. In turn, the pill burden is high among patients with these comorbidities, and it can lead to an increased risk of developing severe drug-drug interactions.

Patients with lung cancer are frequently hospitalized in their last year of life, perhaps more so than patients with any other type of cancer. However, given this, it is not clear how prolonged periods of time spent in the hospital can influence or change a patient’s medication.

Therefore, the researchers aimed to examine the prescription of preventative medication in a cohort of patients with advanced lung cancer at hospital admission and discharge across different health care systems. They also evaluated factors that could have influenced preventative medication prescribing during hospital discharge.

“We hypothesized that a hospital stay would present an opportunity to reduce medications with questionable benefit, and thus, through medicine optimization and hospital discharge, it would be more likely that preventative medication would be discontinued,” they wrote.

In a retrospective cohort study across two centers in the United Kingdom (The Newcastle Hospitals Foundation Trust; 125 patients) and the United States (The University of Texas MD Anderson Cancer Center; 191 patients), the researchers evaluated prescription of preventative medication during hospital admission and discharge for patients who died of lung cancer.

Classes of preventative medication included vitamins and minerals, and anti-diabetic, anti-hypertensive, anti-lipid and anti-platelet medications.

Patients in the UK and the US were approximately 73 and 65 years old, respectively. Both sites included more male patients, and the majority presented with stage 4 disease.

In the UK, the average number of preventative medications prescribed was 1.9 at admission and 1.7 at discharge; meanwhile, in the US, the averages were 2.6 and 1.9, respectively.

During admission, about 73 percent of patients in the UK and 80 percent in the US received a preventative medication. However, the amount reduced to 63 percent in the UK and 69 percent in the US at discharge. The most common prescribed preventative medication were anti-hypertensive agents at the UK site, and vitamin and minerals at the US site.

Overall, the average number of preventative medications was less during hospital discharge compared to admission; however, when the researchers examined this in association with other factors, there was a significant association between the number of preventative drugs at admission and the number of preventative medications during discharge.

“For example, in the UK model, for every one preventative drug at admission, the number of preventative medications at discharge will increase by 1.27… similarly, in the US model, for every one preventative drug at admission, the number of preventative medications at discharge will increase by 1.13,” the researchers wrote.

In addition, the researchers saw a significant association between the total number of drugs prescribed overall during discharge and the number of preventative medications that were given at the same time at both sites.

In the US specifically, the total drugs prescribed during admission, having a palliative care consultation and total medication at discharge were all significantly associated. However, other indicators related to patient and hospital factors were not significantly associated with preventative medications supplied at discharge.

“We have identified a number of key findings that may be of importance to health care practitioners and policy makers: For lung cancer patients who are admitted to (the) hospital, polypharmacy is common,” the researchers wrote.

“The mean number of medications a hospitalized lung cancer patient is prescribed increases after hospital admission. The prescribing of preventative medications is common amongst hospitalized lung cancer patients,” they added. “And patient factors (such as age, cancer stage, cancer type, comorbidity and number of days between discharge and death) and hospital factors (such as length of hospital admission and number of hospitalizations) were not associated with the prescribing of preventative medication.”

The researchers noted that the point of discharging a patient from the hospital might be an appropriate place for physicians to develop an intervention to reduce or to start the process of reducing preventative medication that is burdensome and no longer appropriate given a patient’s reduced life expectancy.

“Further work should explore the nature of the intervention, but it is encouraging that, at the US site, a consultation with a palliative care clinician did appear to be associated with less preventative medication on discharge,” they added.