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Randomized Controlled Trial
. 2019 Apr;34(4):559-566.
doi: 10.1007/s11606-019-04837-7. Epub 2019 Feb 4.

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Yael Schenker  1 , Seo Young Park  2 , Kwonho Jeong  2 , Jennifer Pruskowski  3 , Dio Kavalieratos  4 , Judith Resick  4 , Amy Abernethy  5 , Jean S Kutner  6
Affiliations
Randomized Controlled Trial

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Yael Schenker et al. J Gen Intern Med. 2019 Apr.

Abstract

Background: Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases.

Objective: To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year).

Design: Secondary analysis of baseline data from a trial of statin discontinuation.

Participants: Adults with advanced, life-limiting illness.

Main measures: Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.

Key results: Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient - .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient - .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms.

Conclusions: Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting.

Nih trial registry number: ClinicalTrials.gov Identifier for Parent Study - NCT01415934.

Keywords: end-of-life care; geriatrics; pharmaceutical care; quality of life.

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Conflict of interest statement

Author Amy Abernethy, MD, is an employee of Roche Group/Flatiron Health, has received honoraria from Roche/Genentech in the last 3 years, has stock ownership/options with Athena Health, has a current patent pending for a technology that facilitates the extraction of unstructured information from medical records, and is the owner of Orange Leaf Associates and a senior advisor to Highlander Partners (http://highlander-partners.com/). There are no other conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Symptom burden by polypharmacy group. Low polypharmacy = 0–8 medications; medium polypharmacy = 9–13 medications; high polypharmacy = ≥ 14 medications; p value = < 0.001 (anova) 95% confidence intervals; ESAS, Edmonton Symptom Assessment Scale.
Fig. 2
Fig. 2
Quality of life by polypharmacy group. Low polypharmacy = 0–8 medications; medium polypharmacy = 9–13 medications; high polypharmacy = ≥ 14 medications; p value = < 0.004 (ANOVA) 95% confidence intervals; MQOL, McGill Quality of Life Questionnaire.
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