Preventive Drugs in the Last Year of Life
I had thought these types of treatment had gone by the wayside in treatment during the last year of life. According to an Medscape article they have not.
“‘Physicians should carefully consider whether the prescribed drugs are likely to achieve their benefit within the patient’s remaining lifetime,’ the authors concluded. The study included 151,201 patients ages 65 years and older who died in Sweden at a mean age of 81.3 years from 2007 to 2013. ‘The use and cost of preventive drugs during the last 12 months of life were the main study outcomes.’ The drugs of ‘questionable benefit’ assessed in the current study included antidiabetic drugs, antihypertensives, statins, and bisphosphonates medications for the treatment of chronic anemia and vitamin and mineral supplements.’
Receipt of these long term preventative drugs added 20% to the cost of treatment during the final year of life. ‘The median drug cost during the last year of life was $1,482 (interquartile range $700-$2,896).'”
By run75441 (Bill H)
Wonder when the optimal time to stop, say, statin use would be? Can this be determined?
random:
The article discussion is about preventative drugs and whether they will have an impact on a dying patient with an estimated 1 year left to live. The view is these drugs are “unlikely to achieve their clinical benefit during the patients’ remaining lifespan.” The author’s point is the existence of routine-based prescribing practices that contribute to low-value care or care which will not change or impact the final outcome.
I thought the article was good although seemingly cold hearted if one were to consider some (not all) drugs may provide comfort. Read the Medscape article (linked) and then go to the doctor comments and “all” comments. I believe you will find of the comments interesting and not in agreement.
Two factors for statins: mitigate/lower risk of coronary artery disease and quality of life, taking the statin is no big deal.
The mitigate risk appeals to the minimizer of maximum regret view toward uncertainty. I am on a low dose statin for about 10 years now….. for this reason. My view toward risk is mini max bent in decisions under uncertainty.
Mini max causes one to ‘over diagnose’, that is take out the prostate when presented with a small chance of cancer. Or the less concerning case of abnormal growth on thyroids, which is possibly the most removed organ for cautionary reasons, but also the one that has lesser quality of life issues than say prostate. I have no thyroid, but I would think very hard about giving up my prostate+.
Quality of life, no matter how short, is usually a reason to provide a treatment.
JAMA study suggests that men nearing 70 should not bother with PSA tests……….. I am there.
When you hit 75, all drugs should be stopped. If you live another 20 years, good on ya. If not well you had a good life. FYI I am 70.
Whether to stop PSA tests at 70 depends on family history. A couple of brothers with prostate cancer suggests continued testing a good idea.
Jack D,
I read most of the prostate study. The premise is that many biopsy results that reflect marginal “risks” in the tissue are slow evolving cancers that take many years to spread and the quality of life issues from taking the prostate do not “sell” living past 80……… Which sort of support’s David White.
Family history changes a lot of perspective on cancer screening especially colonoscopy.
Ilsm, indeed, multiple colon cancers in the family history warrants more testing than “usual”.
JackD.
I am (68 yoa) on 5 year plan colonoscopy set for May 23. If “good” likely my last. No family history but I had a few “polyps” first go.