Polypharmacy, steep out-of-pocket costs hound cancer patients at end of life

Polypharmacy frequently occurs in most patients with advanced cancer at end of life, reports a recent study. However, most medications used are usually for supportive care.

In addition, “[p]atients receiving chemotherapy had higher medication-related out-of-pocket (OOP) costs, and chemotherapy was significantly associated with polypharmacy at end of life,” according to the authors, led by Cara L McDermott from the Cambia Palliative Care Center of Excellence, Department of Medicine, University of Washington, Seattle, US.

McDermott and colleagues retrospective analysed insurance enrolment and claims files linked to the Puget Sound Cancer Surveillance System for adults aged ≥18 years who were commercially insured, diagnosed with stage IV cancer, survived 30+ days after diagnosis, and did not enrol in hospice.

The authors then described the prevalence of polypharmacy, chemotherapy use, and medication-related OOP costs in the last month of life.

A total of 606 patients were included in the analysis, of which 390 (64 percent) experienced polypharmacy (ie, 5+ medications) in the last 30 days of life. Nearly half (n=297, 49 percent) received chemotherapy or targeted agents. Notably, chemotherapy contributed to a higher likelihood of polypharmacy (odds ratio [OR], 2.93, 95 percent confidence interval [CI], 2.04‒4.20).

Opioids, benzodiazepines, and antiemetics were the most prescribed medications at end of life.

Of the patients, 484 (80 percent) incurred medication-related costs in the last month of life, with a median total OOP cost of $82, while seven (1 percent) had total costs above $5,000. The median chemotherapy-related OOP cost was $446, with 32 patients (7 percent) having to incur OOP costs between $1,000 and $5,000.

“Evaluation of polypharmacy at end of life may represent an important opportunity to improve quality of life and reduce costs for patients and families,” the authors said.

“Polypharmacy raises the risk of drug-drug interactions and adverse events among patients with cancer,” they noted.