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- Title
Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness.
- Authors
Schenker, Yael; Kavalieratos, Dio; Resick, Judith; Park, Seo Young; Jeong, Kwonho; Pruskowski, Jennifer; Abernethy, Amy; Kutner, Jean S.
- Abstract
<bold>Background: </bold>Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases.<bold>Objective: </bold>To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year).<bold>Design: </bold>Secondary analysis of baseline data from a trial of statin discontinuation.<bold>Participants: </bold>Adults with advanced, life-limiting illness.<bold>Main Measures: </bold>Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.<bold>Key Results: </bold>Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient - .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient - .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms.<bold>Conclusions: </bold>Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting.<bold>Nih Trial Registry Number: </bold>ClinicalTrials.gov Identifier for Parent Study - NCT01415934.
- Subjects
NATIONAL Institutes of Health (U.S.); POLYPHARMACY; QUALITY of life; DISEASES; REGRESSION analysis; SECONDARY analysis
- Publication
JGIM: Journal of General Internal Medicine, 2019, Vol 34, Issue 4, p559
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-04837-7