More medications in advanced life-limiting illness can lower quality of life, increase symptom burden

Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower quality of life, a study found.

To evaluate associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness (defined as clinician-estimated survival of one month to one year), and recent deterioration in functional status, researchers conducted a secondary analysis of baseline data from a trial of statin discontinuation. Polypharmacy was assessed by determining the number of non-statin medications taken regularly or as needed. Symptom burden was assessed by using the Edmonton Symptom Assessment Scale (range, 0 to 90, with higher scores indicating greater symptom burden), while quality of life was assessed by using the McGill Quality of Life Questionnaire (range, 0 to 10, with higher scores indicating better quality of life). Results of the study were published by the Journal of General Internal Medicine on Feb. 4.

Three hundred seventy-two participants were included in the study. Of these, 47% were age 75 years or older and 35% were enrolled in hospice. Fifty-two percent had a cancer diagnosis. The most common noncancer diagnoses were chronic obstructive pulmonary disease, congestive heart failure, and dementia. The mean symptom score was 27.0, with higher scores associated with higher polypharmacy. The mean quality-of-life score was 7.0, with worse total quality of life associated with higher polypharmacy. The average number of non-statin medications was 11.6; one-third of participants took 14 or more medications.

In adjusted models, higher polypharmacy was associated with higher symptom burden, and this association remained significant in fully adjusted linear regression models, implying that each additional medication was associated with a higher symptom burden of 0.81 point on the Edmonton Symptom Assessment Scale, the authors noted. Higher polypharmacy was also associated lower quality of life in unadjusted linear regression models. This association remained significant in adjusted analyses, implying that every additional medication was associated with lower quality of life by 0.06 point on the McGill Quality of Life Questionnaire. Adjusting for symptom burden weakened the association between polypharmacy and quality of life without a significant interaction, which suggests that the decrease in quality of life associated with polypharmacy may be related to medication-associated symptoms, the authors said.

Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted because polypharmacy may be particularly burdensome near the end of life, as patients accumulate medications to treat and prevent multiple diseases, the authors concluded.

“Efforts to alleviate the burden of polypharmacy and improve quality of life for patients with advanced, life-limiting illness will require clinician and patient education, accompanied by patient-centered decision-making. All clinicians caring for older and/or seriously ill patients should learn targeted approaches to deprescribing, and these approaches should be employed routinely,” they wrote.