Prescribing Patterns and Drug Related Problems of Opioid Analgesics and Adjuvant Medications in Patients with End-stage Cancer Receiving Palliative Care Management at a Community Hospital

Abstract

Objective: To determine prescribing pattern on opioids analgesics and adjuvant medications among patients with last-stage cancer receiving palliative care. Drug related problems (DRPs) and their causes, and factors potentially associated with the DRPs were also investigated. Methods: In this retrospective descriptive study, patients with end-stage cancer were selected. Data were collected from inpatient medical records, outpatient medical record and home visit record for 1 year. That were explored and evaluated drug related problem by The PCNE classifications v.7.0 then summarized and analyzed by descriptive statistics and Chi-square test at a significance level of P-value < 0.05. Results: There are 35 inpatients, the majority were male (21 cases or 60% of all patients) with an average age of 61.46 ± 14.98 years. The most diagnosed disease was liver cancer. DRPs during in hospitalization were found with an average of 1.17 DRPs per patient. The most common DRP the effect of drug treatment not optimal (39.02% of all DRPs). The majority cause of DRPs was Inappropriate drug according to guidelines/formulary. At out-patient visits, DRPs were found with an average of 1.30 DRPs per patient.In home visits, an average of 1.16 DRPs per patient was found with most common cause of the effect of drug treatment not optimal. Pain level was significantly associated with having DRP during hospitalization (P-value = 0.046). Conclusion: DRPs were found among patients with terminal cancer receiving palliative care. The findings emphasized optimal medication management with pharmacist involvement. To relieve DRPs, guidelines for opioid analgesics and adjuvant medications management should developed. Such improvement could lead to a rational drug use. Keywords: drug related problem, palliative care, end-stage cancer, analgesics, prescribing pattern