Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Medications at the End of Life Care for Terminal Cancer Patients during Their Last Admission

말기 암 환자의 마지막 입원 동안 임종돌봄시의 약제들

  • Kim, Do-Yeun (Dongguk University-Seoul, Graduate School of Medicine)
  • 김도연 (동국대학교 서울캠퍼스 일반대학원 의학과)
  • Published : 2010.03.01
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Abstract

Purpose: To evaluate medications at the end of life care for terminal cancer patients during their last admission. Methods: Medical records of terminal cancer patients during their last admission from July 2003 to April 2008 at a district academic hospital were evaluated. Patient's characteristics, therapeutic drug classification during their last admission and on the patient's day of death, and the administrated route and number of medications on the patient's day of death were analyzed. Results: Total 81 patients were included. The median patient age was 63 years. The median length of admission was 18 days (range: 1~101). 54% of the patients had more than one comorbidities. The most frequently prescribed drugs during the last admission were opioid analgesics (63%), followed by antibiotics (58%) and antacids (53%). On the day of death, common medications were antibiotics (59%), antacids (58%), and opioid analgesics (46%). Intravenous injection was given to 81% of the patients and intramuscular injection was given to 16% of the patients on the day of patient's death. Number of medications prescribed to patients was between 0 and 11 (median: 3) and 12% (10/81) of the patients took over 8 medications including intravenous and oral drugs on the day of death. 6% (5/81) of the patients took potentially futile medications, like multivitamin or statin until the day of death. Conclusion: This study suggests that potentially futile medications and uncomfortable care were given to terminal cancer patients. Multicenter-based studies are necessary to diminish futile medications by essential medication at the end of life care for terminal cancer patients.

목적: 말기 암환자들의 여명 돌봄 시 약제들을 평가하기 위함이다. 방법: 2005년 7월부터 2008년 4월까지 일개 대학병원에 입원한 말기 암환자들의 임종 전 마지막 입원시의 의무기록을 검토하였다. 환자의 특성, 동반질환, 마지막입원 시와 임종당일 치료약제 분류, 임종일 약제 투여경로와 약제 가지 수를 분석하였다. 결과: 총 81명의 환자가 포함되었고 환자의 중앙 연령은 63세였다. 중앙재원기간은 18일(범위: 1~101)이었다. 54%의 환자들은 적어도 한 개 이상의 동반질환을 가지고 있었다. 마지막 입원 시 가장 많이 처방된 약제들은 오피오이드 진통제(63%), 항생제(58%), 제산제와 항궤양제(53%)였고 임종당일 흔한 약제들은 항생제(59%), 제산제와 항궤양제(58%), 마약성 진통제(46%) 순이었다. 임종당일 정맥 내 주입은 81%의 환자에게 투여되었고 근육주사는 16%의 환자에게 투여되었다. 임종당일 경구약제 투여 가지 수는 0에서 11가지 사이(중앙값: 3)였고 12% (10/81)의 환자들은 정맥 및 경구 투여 포함하여 8가지 이상의 약제를 복용하였다. 6% (5/81) 환자들은 비타민이나 스타틴 계열의 약제들을 임종 시까지 복용하고 있었다. 결론: 이 연구는 말기 암환자들에게 의미가 없을 수 있는 약제들과 이로 인한 불편한 돌봄이 제공됨을 시사한다. 말기 암환자들의 여명 돌봄 시 필수약제들의 투여와 불필요한 약제의 투여 중단으로 무의미한 약제투여를 줄이기 위한 추후 연구가 필요하다.

Keywords

References

  1. De Lima L. International Association for Hospice and Palliative Care list of essential medicines for palliative care. Ann Oncol 2007;18:395-9.
  2. De Lima L, Doyle D. The International Association for Hospice and Palliative Care list of essential medicines for palliative care. J Pain Palliat Care Pharmacother 2007;21:29-36. https://doi.org/10.1080/J354v21n03_05
  3. Riechelmann RP, Krzyzanowska MK, Zimmermann C. Futile medication use in terminally ill cancer patients. Support Care Cancer 2009;17:745-8. https://doi.org/10.1007/s00520-008-0541-y
  4. Riechelmann RP, Moreira F, Smaletz O, Saad ED. Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol 2005;56:286-90. https://doi.org/10.1007/s00280-004-0998-4
  5. Nauck F, Ostgathe C, Klaschik E, Bausewein C, Fuchs M, Lindena G, et al. Drugs in palliative care: results from a representative survey in Germany. Palliat Med 2004;18:100-7. https://doi.org/10.1191/0269216304pm852oa
  6. Curtis EB, Walsh TD. Prescribing practices of a palliative care service. J Pain Symptom Manage 1993;8:312-6. https://doi.org/10.1016/0885-3924(93)90160-W
  7. McPherson ML. Performing a medication regimen review in hospice and palliative care. Am J Hosp Palliat Care 2001;18:193-9. https://doi.org/10.1177/104990910101800311
  8. Vollrath AM, Sinclair C, Hallenbeck J. Discontinuing cardiovascular medications at the end of life: lipid-lowering agents. J Palliat Med 2005;8:876-81. https://doi.org/10.1089/jpm.2005.8.876
  9. Fahlman C, Lynn J, Finch M, Doberman D, Gabel J. Potentially inappropriate medication use by Medicaid+Choice beneficiaries in the last year of life. J Palliat Med 2007;10:686-95. https://doi.org/10.1089/jpm.2006.0215
  10. Riechelmann RP, Krzyzanowska MK, O'Carroll A, Zimmermann C. Symptom and medication profiles among cancer patients attending a palliative care clinic. Support Care Cancer 2007;15:1407-12. https://doi.org/10.1007/s00520-007-0253-8
  11. Chen LK, Chou YC, Hsu PS, Tsai ST, Hwang SJ, Wu BY, et al. Antibiotic prescription for fever episodes in hospice patients. Support Care Cancer 2002;10:538-41. https://doi.org/10.1007/s00520-002-0377-9
  12. Reinbolt RE, Shenk AM, White PH, Navari RM. Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manage 2005;30:175-82. https://doi.org/10.1016/j.jpainsymman.2005.03.006
  13. Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, et al. Antibiotic use during the last days of life in cancer patients. Eur J Cancer Care 2006;15:74-9. https://doi.org/10.1111/j.1365-2354.2005.00603.x
  14. Shin HR, Jung KW, Won YJ, Kong HJ, Yim SH, Sung J, et al. National cancer incidence for the year 2002 in Korea. Cancer Res Treat 2007;39:139-49. https://doi.org/10.4143/crt.2007.39.4.139
  15. Koh SJ, Lee KS, Hong YS, Yoo YS, Park HJ. Clinical change of terminally ill cancer patients at the end-of-life time. Korean J Hosp Palliat Care 2008;11:99-105.
  16. Yennurajalingam S, Zhang T, Bruera E. The impact of the palliative care mobile team on symptom assessment and medication profiles in patients admitted to a comprehensive cancer center. Support Care Cancer 2007;15:471-5. https://doi.org/10.1007/s00520-006-0172-0