Document Type : Brief Report(s)
Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Internal Medicine, Oncology and Hematology Section, Faculty of Medicine, Isfahan University Medical Sciences, Isfahan, Iran
Background: Palliative cancer patients suffer from a condition which needs to take many medications for supportive care and comorbid illnesses management. Therefore, they are at risk of drug-rated problems, such as futile medications. We aimed to discover the futile medication occurrence and identification as well as medication futility associated predictor factors.
Method: In a prospective cross-sectional study, we included patients with advanced/incurable malignancies admitted to Ala palliative clinic, a charity clinic affiliated to Omid Hospital in Isfahan, Iran, between June 2018 and April 2019. To identify the use of fruitless medicine towards the end of life, we conducted a thorough analysis of the demographic information and prescription lists of terminally ill patients. The phrase "futile drugs" refers to those that are superfluous or redundant, have no significant benefits in terms of illness symptom management or survival time extension, or have a long-term chronic usage.
Results: From 133 involved patients, 114 (85.7%) were considered to use at least one futile medication (including only administration of unnecessary medications (70%) or both unnecessary and duplicate medication (30%). 35 patients were encountered with 48 medication duplications of the different pharmacological class of medications mostly opioids (33%). According to multivariate logistic regression analysis, the number of drugs and the average time to death were related with the prevalence of medication futility.
Conclusion: Palliative cancer patients were exposed to taking futile medications. More different prospective studies are warranted to evaluate the clinical and economic impact of futile medication use in oncology practice.
How to cite this article:
Mahzoni H, Sharifi M, Moghaddas A. Futile medication in palliative cancer patients; a report from the Middle East. Middle East J Cancer. 2023;14(2):309-15. doi: 10. 30476/mejc.2022.93301.1683
- Rezaei Aderyani M, Nazari Tavakkoli S, Kiani M, Abbasi M, Javadi M. Medical futility, useless or frivolity? [In Persian] Iranian Journal of Medical Ethics and History of Medicine (IJME). 2017;10:282-90.
- Brown GT. Medical futility in concept, culture, and practice. J Clin Ethic. 2018;29:114-23.
- Riechelmann RP, Krzyzanowska MK, Zimmermann C. Futile medication use in terminally ill cancer patients. Support Care Cancer. 2009;17(6):745-8. doi:10.1007/s00520-008-0541-y.
- Jukić M, Šarić L, Prkić I, Puljak L. Medical futility treatment in intensive care units. Acta Med Acad. 2016;45(2):135-44. doi: 10.5644/ama2006-124.169.
- Curtis JR, Patrick DL, Caldwell ES, Collier AC. The attitudes of patients with advanced AIDS toward use of the medical futility rationale in decisions to forego mechanical ventilation. Arch Intern Med. 2000;160(11):1597-601. doi: 10.1001/archinte.160.11.1597.
- Frick S, Uehlinger DE, Zuercher Zenklusen RM. Medical futility: predicting outcome of intensive care unit patients by nurses and doctors--a prospective comparative study. Crit Care Med. 2003;31(2):456-61. doi: 10.1097/01.CCM.0000049945.69373.7C.
- Aghabarary M, Dehghan Nayeri N. Medical futility and its challenges: a review study. J Med Ethics Hist Med. 2016;9:11.
- Lee HR, Yi SY, Kim DY. Evaluation of prescribing medications for terminal cancer patients near death: Essential or futile. Cancer Res Treat. 2013;45(3):220-5. doi: 10.4143/crt.2013.45.3.220.
- von Gruenigen VE, Daly BJ. Futility: clinical decisions at the end-of-life in women with ovarian cancer. Gynecol Oncol. 2005;97(2):638-44. doi: 10.1016/j.ygyno.2005.01.031.
- Moghaddas A, Adib-Majlesi M, Sabzghabaee AM, Hajigholami A, Riechelmann R. Potential drug-drug Interactions in hospitalized cancer patients: A report from the Middle-East. J Oncol Pharm Pract. 2021;27(1):46-53. doi: 10.1177/1078155220910209.
- Currow DC, Stevenson JP, Abernethy AP, Plummer J, Shelby-James TM. Prescribing in palliative care as death approaches. J Am Geriatr Soc. 2007;55(4):590-5. doi: 10.1111/j.1532-5415.2007.01124.x.
- Tavousi F, Sadeghi A, Darakhshandeh A, Moghaddas A. Potential drug-drug interactions at a referral pediatric oncology ward in Iran: A cross-sectional study. J Pediatr Hematol Oncol. 2019;41(3):e146-e151. doi:10.1097/MPH.0000000000001346.
- Fede A, Miranda M, Antonangelo D, Trevizan L, Schaffhausser H, Hamermesz B, et al. Use of unnecessary medications by patients with advanced cancer: cross-sectional survey. Support Care Cancer. 2011;19(9):1313-8. doi: 10.1007/s00520-010-0947-1.
- Abolhassani H, Naseri M, Mahmoudzadeh S. A survey of complementary and alternative medicine in Iran. Chin J Integr Med. 2012;18(6):409-16. doi: 10.1007/s11655-012-1124-9.
- Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, et al. A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ. 2003;327(7408):195-8. doi: 10.1136/bmj.327.7408.195.