Dr Arjun Poudel is a Postdoctoral Research Associate in the School of Clinical Sciences at Queensland University of Technology. His research expertise relates to the determinants of health and well-being of older people, and quality of prescribing for the frail aged across the continuum of care. He has keen interest in areas around medication use in older population with extensive experience researching on medication optimisation in frail older people with further exploration on determinants of health and well-being of people with life limiting illnesses. He has made significant contributions to the field of quality use of medicines especially in older populations and have an established and significant track record in this area
Arjun completed his doctoral training at the University of Queensland in 2015. He is currently researching on optimisation of medication in patients with life limiting illnesses. Dr Poudel also provides mentoring and supervising role for research higher degree students. Currently he is supervising two PhDs and two higher degree research students.
Unnecessary preventive medication use in older, terminally ill cancer patients.
Background: Patients with life limiting cancer are often prescribed multiple medications to control acute symptoms and also to prevent or treat other long-term co-morbid conditions. These include hypertension, diabetes mellitus, and hyperlipidaemia. Early identification of unnecessary preventive medications at the end of life can improve quality of life. Limited research has investigated whether preventive medications are withdrawn in terminally ill cancer patients.
Objectives: To evaluate the prevalence of preventive medication use in a sample of terminally ill older cancer patients at least 6 months prior to death.
Methods: The sample comprised patients aged 65 years or older referred to a major Australian cancer centre between September 2010 and November 2011 with a diagnosis of locally advanced or metastatic cancer. Medication use at least 6 months prior to death was evaluated.
Results: A total of 50 patients were included in this project. They had a mean (SD) age of 71.5 (5.2) years and 66% were male. On average, patients were prescribed 7.9 (± SD 2.7; range 2-15) medications. Polypharmacy was observed in 60% and hyper-polypharmacy in 26% patients respectively. A significant proportion of patients continued to use preventive medications until death. The most prescribed preventive medication classes were angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB) and statins, prescribed in 46% and 38% of total patient population.
Conclusions: Our results indicate that unnecessary preventive medications were prescribed till death in several patients. This suggests that there is an opportunity to identify and withdraw unnecessary medication earlier in the disease trajectory to enhance quality of life.
Keywords: cancer, end of life, limited life expectancy, medication withdrawal, polypharmacy, preventive medications, terminally ill