Study addresses issue of when to discontinue medications for non-fatal conditions
A STUDY has put into light one of the main issues faced by clinicians today in treating terminally ill patients in a study that found an improvement in quality of life of terminally ill patients after stopping cholesterol-lowering drugs.
“The issues is whether some longstanding medication such as cholesterol-lowering drugs might safely be discontinued, but there has been little research to help guide clinicians in making that recommendation,” said lead author Amy Abernethy, M.D., Ph.D., director of the Center for Learning Health Care at the Duke Clinical Research Isntitute.
In her study presented at the American Society of Clinical Oncology in Chicago, she and her team found that stopping statins in patients with advanced illnesses resulted in improved overall quality of life, lower costs, and no increased deaths. They, in fact, found that the patients who stopped taking statins appeared to live slightly longer.
Abernethy enrolled 381 patients who face the likelihood of dying within a year and who have been taking statins for at least three months. Roughly half were randomized to continue taking the drug while the other half discontinued it.
Among the 192 study patients who continued statins, the median survival was 190 days and the 192 participants who stopped statins had a median survival of 229 days.
The researchers followed the patients for up to a year to monitor survival, cardiovascular events, and changes in the quality of life.
“Our study found that patients who discontinued statins reported improvements in quality of life. This runs counter to the idea that discontinuing a treatment would cause people to somehow feel that they were getting less care or inadequate care,” said Dr. Abernethy who also explained that statins was a good candidate to explore the issue, because the drug is widely prescribed, and benefits can take years to accumulate. The researchers are also considering eventually including medications for blood pressure and blood clots in the study.
Those who discontinued statins in the study also reported a better overall quality of life, particularly in their psychological wellbeing, and saved money of about US$ 716 per person over the course of the trial for name-brand drugs, and $629 for generics. They also estimated the overall savings based on US population estimates if patients in the late stages of fatal illnesses were to cut out statins.
“This is a decision that needs to be discussed between patients and their doctors; it’s not something that should be done independently or in a one-size-fits-all manner,” she said.
“These are conversations that need to be had. This brings us to a new era of asking how to right-size care, and how to bring evidence to that issue. There is an important message her- that taking away isn’t always bad.” With www.ScienceDaily. com report
VitalSigns Issue 64 Vol. 3, June 1-30, 2014