Current Status of Drug Prescribing among Older Adults with Advanced-stage Cancer Receiving Home Medical Care in...

Balancing preventive and symptomatic medications is crucial to minimizing polypharmacy in older adults with limited life expectancy. This study examined end-of-life medications among older adults with advanced-stage cancer receiving home medical care.

We conducted a retrospective cohort study using Japan's national claims database between October 2017 and September 2019 and selected adults aged ≥75 years who received comprehensive home medical care services for patients with advanced-stage cancer. We compared prescriptions for preventive and symptomatic medications during two periods: (1) within 180 days before the first claim for the service issued (index date) and (2) within 180 days after the index date or until death.

Overall, the study included 8,463 participants, of whom 47% were women and 46% were aged ≥85 years. The median observation period after the index date was 57 days (interquartile range: 30-131 days). Among preventive drugs, antihypertensives were the most frequently prescribed before the index date (60.3%), followed by lipid-lowering drugs (25.4%) and antiplatelets (21.7%). Prescription of lipid-lowering drugs, vitamins, and drugs for osteoporosis decreased by approximately 70%-80% after the index date. In contrast, prescription of oral anticoagulants, antidiabetic drugs, and antidementia drugs declined by approximately 40%. Symptomatic drug prescriptions also decreased after the index date, except for opioids (from 42.2% to 51.9%).

This is the first nationwide study to examine the prescriptions of preventive and symptomatic drugs among older adults with advanced-stage cancer receiving end-of-life home medical care.