Injustifiable use of gastroprotection in advanced cancer patients

The aim of this survey was to prospectively collect data about gastroprotector prescription at admission of an acute pain relief and palliative care unit. An observational survey was performed on three-hundred consecutive patients. Reasons for admission, concomitant treatment and use of drugs were recorded at admission. About 60.6% patients had been prescribed proton pump inhibitors or anti-H2 receptors agents. Of these patients, possible risk factors were nonsteroidal anti-inflammatory drugs (41, 22.5%), corticosteroids (43, 23.6%), age > 75 years (27, 14.8%). In only 25 admissions (13.7%) prescription corresponded to Italian drug agency recommendations with an odds ratio of an off-label prescription of 7.28. In a relatively high percentage of admissions (55%), patients receiving gastroprotectors were on chemotherapy, with an odds ratio of 1.42. This survey showed that gastroprotectors are often prescribed regardless of Health Care System regulations, as only a minority of patients satisfied the requirements of an appropriate and refundable prescription. The attitudes of oncologists who prescribe gastroprotectors for a putative protective effects are not supported by evidence. Health Care Service in Italy should be aware of these problems to improve the strategies of budgeting the drug expense in a better way or providing further guidelines based on studies able to demonstrate the real cost-benefit ratio of this class of drugs.