Appropriate use of medication among home care adult cancer patients at end of life: a retrospective observational study.

BACKGROUND: Medications are commonly used for symptom control in cancer patients at the end of life. This study aimed to evaluate medication utilization among home care palliative patients with cancer at the end of life and assess the appropriateness of these medications. METHOD: This retrospective observational study included adult cancer patients who received home care in 2020. Medications taken during the last month of the patient's life were reviewed and classified into three major categories: potentially avoidable, defined as medications that usually have no place at the end of life because the time to benefit is shorter than life expectancy; medications of uncertain appropriateness, defined as medications that need case-by-case evaluation because they could have a role at the end of life; and potentially appropriate, defined as medications that provide symptomatic relief. RESULTS: In our study, we enrolled 353 patients, and 2707 medications were analyzed for appropriateness. Among those, 1712 (63.2%) were classified as potentially appropriate, 755 (27.9%) as potentially avoidable, and 240 (8.9%) as medications with uncertain appropriateness. The most common potentially avoidable medications were medications for peptic ulcers and gastroesophageal reflux disease (30.5%), vitamins (14.6%), beta-blockers (9.8%), anticoagulants (7.9%), oral antidiabetics (5.4%) and insulin products (5.3%). Among the potentially appropriate medications, opioid analgesics were the most frequently utilized medications (19.5%), followed by laxatives (19%), nonopioid analgesics (14.4%), gamma-aminobutyric acid analog analgesics (7.7%) and systemic corticosteroids (6%). CONCLUSION: In home care cancer patients, approximately one-third of prescribed medications were considered potentially avoidable. Future measures to optimize medication use in this patient population are essential.

Descriptive study of clinical pharmacist interventions in adult hospice and palliative care at a comprehensive oncology center in Jordan.

INTRODUCTION: Few studies have evaluated the role of a clinical pharmacist in hospice and palliative care in oncology. We aimed to describe the intervention of a clinical pharmacist in hospice and palliative care at a comprehensive oncology center in Jordan. METHODS: A retrospective descriptive study at a comprehensive oncology center in Jordan between 2006 and 2019. Quantifi® pharmacy documentation system was used to retrieve the clinical pharmacists' interventions in three hospice and palliative care settings, inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care. Where clinical pharmacists document their interventions, significance and acceptance of the interventions by the physician is done using Quantifi®. RESULTS: Over 13 years, 27,720 documented interventions were retrieved in the three settings of hospice and palliative care: inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care setting. The most common reported interventions were drug therapy recommendation/discontinuation (41%), followed by medication reconciliation (21.7%) and patient counseling (16.8%). The medication classes most commonly associated with the hospice and palliative care clinical pharmacist interventions were analgesics (20.9%), antibiotics (19.7%), followed by medications for the nervous system (12.4%). The acceptance rate of the interventions by physicians was around (90%) and 100% of the interventions were considered significant. CONCLUSION: Our study showed the high impact of the hospice and palliative care clinical pharmacist in oncology providing the high number of clinical pharmacists' interventions.