A Study of Medication Use of Cancer and Non-Cancer Patients in Home Hospice Care in Singapore: A Retrospective Study from 2011 to 2015

Abstract

Background: In recent years, there has been a rising demand for home hospice care in Singapore and globally. Studies have shown that polypharmacy and the use of potentially inappropriate medications (PIMs) remain prevalent in palliative care patients. This is commonly associated with increased adverse drug reactions and hospitalization. However, research on medication use in hospice care and its appropriateness is lacking in Asian settings. Objective: (1) To describe the medication use among cancer and non-cancer patients in home hospice care settings in Singapore at two time points, on the day of referral and at death. (2) To describe the discontinuation patterns of medications and assess their appropriateness. Design: This retrospective study analyzed 6158 cancer and 780 non-cancer cases referred to HCA Hospice Care (HCA), Singapore. Sociodemographic, clinical, and medication data were extracted from electronic medical records. The OncPal Deprescribing Guideline (OncPal) was utilized to assess the appropriateness of discontinuation of medications. Results: Non-cancer patients had a higher mean number of medications at admission and death, with 7.84 and 7.07 medications, respectively (p < 0.05), compared with cancer patients, with 5.65 and 5.69 medications, respectively (p = 0.372). The top medications for all patients were laxatives, opioids, and proton pump inhibitors (PPIs). These were mainly used for symptom control. PPI was the main PIM identified by OncPal. Conclusion: Despite being close to end of life and on hospice care, majority of patients still experienced significant medication burden. Continuous assessment of PIMs for their appropriateness based on clinical indications is imperative to reduce polypharmacy.

Keywords: OncPal; Singapore; deprescribing; home hospice; medication use; palliative care.