Potentially inappropriate medications (PIMs) impose a considerable load on individuals with advanced cancer who are approaching the final stages of life. Nonetheless, the patterns of PIM prescriptions and the variables influencing their discontinuation in this patient group remain unclear. To outline the changes over time in PIM prescribing practices and to examine the elements connected with deprescribing PIMs in patients diagnosed with advanced cancer in Japan. Retrospective cohort study drawing on medical claims data. We reviewed records of patients exceeding 65 years of age who had received a cancer diagnosis 6 months before death and who died between December 2017 and August 2023 in Mito City, Ibaraki Prefecture, Japan. Sociodemographic details, clinical information, and prescription records were extracted at 6 months (M6), 3 months (M3), and 1 month (M1) before death. Assessment of PIMs followed the OncPal Deprescribing Guidelines.
In the group of 1269 patients, the average age was 80.6 years, with 62.2% male. PIMs had been prescribed to 77.0% at M6, 76.4% at M3, and 70.0% at M1 (P < 0.001, M6 to M1). Variables linked to the removal of at least one PIM between M6 and M1 encompassed female gender, the quantity of medications at M6, the count of coexisting conditions, admission to a palliative care unit, and admission to a standard hospital ward. For patients with advanced cancer, reliance on PIMs lessened progressively as they neared death. The practice of deprescribing PIMs proved more widespread among female patients, those experiencing polypharmacy together with multiple comorbidities, and those receiving inpatient care, most notably within palliative care units.
