Impact of the deprescribing timing on medicines optimisation in older cancer patients receiving hospice care at the end of life: a comparative cohort study

Background
Deprescribing, the systematic discontinuation of potentially inappropriate medications, is essential for optimising end-of-life care in older cancer patients, particularly in hospice settings. While the benefits of deprescribing are recognised, the timing of these interventions and their impact on patient outcomes, such as survival, remain underexplored.

Aim
This study aimed to compare the effects of deprescribing timing on medication appropriateness and survival time in older hospice cancer patients.

Methods
A retrospective, observational cohort study that reviewed the medical records of all decedents aged 65 years and older who received palliative care consults in hospice settings was conducted between January 1 and December 31, 2022. Data collected included Palliative Performance Scale (PPS) scores and prescribed medications. Patients were categorised into early deprescribing (interventions initiated more than 30 days, but less than 180 days before death) and late deprescribing (within 30 days of death) groups. Unexpected deaths were excluded. Medication appropriateness was assessed using the OncPal deprescribing guideline.

Results
Among 155 decedents, early deprescribing was associated with longer median survival time (81 versus 17 days; P < 0.001). Both early and late interventions significantly reduced preventive medications (4.6–1.6, 4.8–1.5, respectively; P < 0.001) and increased symptom control medications (3.6–6.0 and 3.7–5.5, respectively; P < 0.001). Late deprescribing was more common in patients with lower PPS scores (≤ 30%) and haematologic cancers.

Conclusion
Early deprescribing in hospice care was associated with longer survival and improved symptom management, though this may reflect underlying patient characteristics rather than a direct effect of deprescribing.