Rethinking Medications at the End of Life for Patients With Advanced Cancer

As people with advanced cancer approach the end of life, treatment priorities often shift from long-term disease prevention to comfort, symptom control and quality of life. However, many patients continue taking medications originally prescribed years earlier, even when those drugs may no longer provide meaningful benefit, according to research published in Palliative Care & Social Practice.

At six months before death, 77% of patients were taking at least one potentially inappropriate medication. That number declined to 70% by one month before death. Despite this reduction, most patients continued to receive medications intended for long-term disease prevention rather than symptom relief.

This data was garnered from a retrospective study from Japan, which sheds light on how often these potentially inappropriate medications are prescribed in older adults with advanced cancer and which factors are linked to stopping them in the final months of life.

According to the research, deprescribing is not simply stopping medications, but is a thoughtful process that considers prognosis, symptom burden and patient goals. In advanced cancer, medications that take years to provide benefit may no longer align with a patient’s priorities. Rather than focusing on disease prevention, deprescribing aims to support comfort and quality of life during a vulnerable period.

Medication use at the end of life in advanced cancer

Researchers analyzed medical claims data from 1,269 patients aged older than 65 years who died from cancer between 2017 and 2023 in Mito City, Japan. Using a tool designed specifically for patients with advanced cancer and limited life expectancy, investigators assessed how often patients were prescribed potentially inappropriate medications and whether those medications were discontinued over time.

Diagnoses, hospital admissions and prescription records were analyzed at multiple time points before death.

Potentially inappropriate medications were defined according to the OncPal Deprescribing Guidelines, which are specifically designed for patients with advanced cancer and a life expectancy of less than six months.

Which medications were stopped and which were not?

Several classes of preventive medications were commonly discontinued as patients neared the end of life. These included:

• Cholesterol-lowering drugs
• Antihypertensive medications
• Oral diabetes medications
• Antiplatelet drugs
• Osteoporosis treatments
• Vitamins and mineral supplements

In contrast, medications used for peptic ulcer prevention remained consistently prescribed throughout the final months of life. Researchers suggested this may be because patients with advanced cancer often receive steroids or nonsteroidal anti-inflammatory drugs for symptom control, which can increase gastrointestinal risk.

Why potentially inappropriate medications matter

Older adults with advanced cancer often experience polypharmacy, commonly defined as taking five or more medications at the same time. In this study, patients were taking an average of seven medications throughout the final six months of life.

Potentially inappropriate medications can increase the risk of adverse drug reactions (side effects), drug/drug interactions, dizziness, falls and reduced quality of life. For patients with limited life expectancy, the potential harms of continuing preventive medications may outweigh their benefits.

Although some medications labeled as “potentially inappropriate” may still be justified for symptom management, preventive drugs often warrant careful reassessment.

Who was most likely to have medications stopped?

Certain patient characteristics were strongly associated with deprescribing at least one potentially inappropriate medication between six months and one month before death. These included:

• Female patients
• A higher number of medications at six months
• A greater number of non-cancer comorbidities
• Admission to a hospital, especially a palliative care unit

Admission to a palliative care unit was the strongest factor associated with deprescribing, suggesting that specialized palliative care teams may be more proactive in reviewing and optimizing medication regimens.

The findings highlight the role of hospital admission, particularly to palliative care units, in prompting medication reassessment. Hospitalization often involves multidisciplinary teams who may identify opportunities to discontinue unnecessary medications.

However, the study could not determine whether deprescribing decisions were proactive or reactive, nor did it evaluate patient-reported outcomes such as symptom relief or satisfaction.

What this means for patients and caregivers

For patients with advanced cancer and their families, the study reinforces the importance of regular medication reviews, especially as goals of care evolve. Asking whether each medication still provides benefit can open meaningful conversations with oncology and palliative care teams.

References

1. Trends in prescriptions and factors associated with discontinuation of potentially inappropriate medications in elderly patients with advanced cancer at the end of life: A retrospective cohort study, by Dr. Shoichi Masumoto, et al. Palliative Care & Social Practice.

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