Background Palliative care provides many advantages to patients who face life-threatening illness. The five most common symptoms that usually occur in the last days of life are pain, nausea and vomiting, restlessness, dyspnoea and respiratory tract secretions. Supportive treatment for pain and symptom relief should be incorporated into treatment to address these issues.
Purpose The aim of this retrospective study was to compare the use of medicines in the last six days of life in patients treated according to a palliative or standard treatment pathway.
Materials and Methods Inclusion criteria were treatment at the Institute of Oncology, Ljubljana, Slovenia, within the last 6 days of life and the diagnosis of advanced or metastatic cancer. 25 patients were included in the palliative treatment pathway, whereas 25 were treated according to standard treatment pathway and served as a control group. Both groups were comparable in terms of the primary tumour site and median age of the patients.
Results The majority of patients in both groups received strong opioid analgesics. Other medicines to relieve symptoms, such as haloperidol, midazolam, dexamethasone, butylscopolamine and metoclopramide, were more likely to be administered in the palliative group. Polypharmacy was a common problem observed in both groups. However, patients treated according to the palliative treatment pathway received on average 10 medicines, whilst those in control group 14. The cost of medicines was 2.7-fold lower in the palliative group, 15€ compared to 42€ per patient per day. The difference was mainly attributed to unnecessary prescribing of low-molecular weight heparins, systemic antimicrobial medicines and parenteral nutrition.
Conclusions Palliative care is given to improve the quality of life of patients with serious or life-threatening disease, such as cancer. The goal is to prevent the symptoms and side effects of advanced disease, and not to cure. In our opinion, the essential medicines in palliative setting are analgesics, antiemetics, sedatives, anxiolytics and anticholinergics. Other, unnecessary, medicines should be omitted from the treatment.
No conflict of interest.
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