Medicine Use and Management in Palliative Care

A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 10824

Special Issue Editor


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Guest Editor
Department of Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA
Interests: geriatrics; polypharmacy; health disparities

Special Issue Information

Dear Colleagues,

Medication management in palliative patients is a complex and dynamic process requiring shared decision-making between patients, their family members, and the interdisciplinary team. As the serious illness progresses, the goals of therapy may shift from curative intent to disease modification, and to purely symptom management. Clinicians often feel challenged when engaging in difficult conversations regarding the benefits and burdens of continuing or discontinuing medications in palliative patients. The scope of this Special Issue “Medication Use and Management in Palliative Care” of Pharmacy is to disseminate health outcome studies, novel interventions, case studies, and drug reviews on topics related to pharmacotherapy in managing symptoms of patients receiving palliative care. Of particular interest are articles featuring advances in deprescribing, pain and symptom management, hydration and nutrition to improve the quality of care of patients receiving palliative care. New practice reports about how new strategies are adopted in palliative care or hospice settings to improve medication use using an interdisciplinary approach will also be considered.

Prof. Dr. Ivy O. Poon
Guest Editor

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Keywords

  • medication management
  • hospice
  • palliative care
  • symptom management
  • interdisciplinary team
  • pharmacy
  • pharmacology
  • deprescribing
  • medication discontinuation

Published Papers (6 papers)

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Research

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14 pages, 2061 KiB  
Article
Drug Therapy Safety in Palliative Care—Pharmaceutical Analysis of Medication Processes in Palliative Care
by Lisa Krumm, Claudia Bausewein and Constanze Rémi
Pharmacy 2023, 11(5), 160; https://doi.org/10.3390/pharmacy11050160 - 7 Oct 2023
Viewed by 1691
Abstract
Pharmacotherapy plays a crucial role in symptom management in palliative care and is associated with risks potentially leading to drug-related problems (DRP). Pharmacists can identify DRPs and advise prescribers on optimizing drug therapy. The aim of this study was to identify DRP in [...] Read more.
Pharmacotherapy plays a crucial role in symptom management in palliative care and is associated with risks potentially leading to drug-related problems (DRP). Pharmacists can identify DRPs and advise prescribers on optimizing drug therapy. The aim of this study was to identify DRP in a palliative care unit (PCU) and evaluate corresponding pharmaceutical interventions. A non-randomized before-and-after study in a PCU starts with a control phase, an interphase, and an intervention phase. Primary endpoint: DRP, including pharmaceutical interventions and their acceptance. The medication of all inpatients was recorded at set time points, assessed for potential and manifest DRP, and categorized. In the control phase, the ward pharmacist did not interfere with the clinical team. In the intervention phase, the pharmacist could intervene when a DRP was identified and give recommendations. During the 12-month period, 284 patients were included (control phase n = 138; intervention phase n = 146) and 1079 DRPs were identified (control phase n = 634; intervention phase n = 445). The number of DRPs/patient was significantly reduced by the pharmacist’s interventions between the control and intervention phases (4 vs. 3 DRPs, p = 0.001). Overall acceptance of pharmaceutical interventions by prescribers was very high (227/256; 88%). DRPs are hardly preventable. With a clinical pharmacist as a member of the palliative care team, it is possible to reduce the number of DRPs and identify potential problems earlier. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
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Review

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12 pages, 809 KiB  
Review
Evolution of Telehealth—Its Impact on Palliative Care and Medication Management
by Syed N. Imam, Ursula K. Braun, Mary A. Garcia and Leanne K. Jackson
Pharmacy 2024, 12(2), 61; https://doi.org/10.3390/pharmacy12020061 - 2 Apr 2024
Viewed by 1050
Abstract
Palliative care plays a crucial role in enhancing the quality of life for individuals facing serious illnesses, aiming to alleviate suffering and provide holistic support. With the advent of telehealth, there is a growing interest in leveraging technology to extend the reach and [...] Read more.
Palliative care plays a crucial role in enhancing the quality of life for individuals facing serious illnesses, aiming to alleviate suffering and provide holistic support. With the advent of telehealth, there is a growing interest in leveraging technology to extend the reach and effectiveness of palliative care services. This article provides a comprehensive review of the evolution of telehealth, the current state of telemedicine in palliative care, and the role of telepharmacy and medication management. Herein we highlight the potential benefits, challenges, and future directions of palliative telemedicine. As the field continues to advance, the article proposes key considerations for future research, policy development, and clinical implementation, aiming to maximize the advantages of telehealth in assisting individuals and their families throughout the palliative care journey. The comprehensive analysis presented herein contributes to a deeper understanding of the role of telehealth in palliative care and serves as a guide for shaping its future trajectory. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
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16 pages, 1949 KiB  
Review
A Systematic Review of Naldemedine and Naloxegol for the Treatment of Opioid-Induced Constipation in Cancer Patients
by Ursula K. Braun, Leanne K. Jackson, Mary A. Garcia and Syed N. Imam
Pharmacy 2024, 12(2), 48; https://doi.org/10.3390/pharmacy12020048 - 6 Mar 2024
Viewed by 1713
Abstract
Background: Opioid-induced constipation (OIC) is a pervasive and distressing side effect of chronic opioid therapy in patients with cancer pain, significantly impacting their quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAS) were developed for treatment-resistant OIC but most studies were conducted with [...] Read more.
Background: Opioid-induced constipation (OIC) is a pervasive and distressing side effect of chronic opioid therapy in patients with cancer pain, significantly impacting their quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAS) were developed for treatment-resistant OIC but most studies were conducted with non-cancer patients. Objective: to discuss two oral formulations of PAMORAs, naldemedine and naloxegol, and to review available evidence of the effectiveness of these drugs for OIC in cancer patients. Methods: a comprehensive search to identify primary literature for either naldemedine or naloxegol for OIC in cancer patients. Results: Only three prospective randomized, double-blind, placebo-controlled clinical trials for naldemedine enrolling cancer patients were identified; the results of a subgroup analysis of two of those studies and two non-interventional post marketing surveillance studies of these trials are also reported here. For naloxegol, only two randomized controlled trials were identified; both were unsuccessful in enrolling sufficient patients. An additional four prospective non-interventional observational studies with naloxegol were found that enrolled cancer patients. There were significantly higher rates of responders in the PAMORA groups than in the placebo groups. The most common side effect for both PAMORAs was diarrhea. Limitations: All studies were industry-funded, and given that only three trials were randomized controlled studies, the overall quality of the studies was lacking. Conclusion: Naldemedine or naloxegol appeared safe and useful in the treatment of OIC in cancer patients and may improve their quality of life. Larger-scale randomized placebo-controlled studies of PAMORAs in cancer patients would strengthen existing evidence. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
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9 pages, 233 KiB  
Review
Rational Prescribing of Pancreatic Enzymes for Patients with Pancreatic Cancer
by Mary Acelle G. Garcia, Syed Imam, Ursula K. Braun and Leanne K. Jackson
Pharmacy 2024, 12(2), 47; https://doi.org/10.3390/pharmacy12020047 - 6 Mar 2024
Viewed by 1631
Abstract
Most patients with pancreatic cancer at some point present with symptoms related to exocrine pancreatic insufficiency (EPI). These include diarrhea, abdominal bloating, indigestion, steatorrhea, weight loss, and anorexia. Even though up to 80% of pancreatic cancer patients eventually present with symptoms related to [...] Read more.
Most patients with pancreatic cancer at some point present with symptoms related to exocrine pancreatic insufficiency (EPI). These include diarrhea, abdominal bloating, indigestion, steatorrhea, weight loss, and anorexia. Even though up to 80% of pancreatic cancer patients eventually present with symptoms related to exocrine pancreatic insufficiency, only 21% are prescribed pancreatic enzyme replacement therapy (PERT). Its effectiveness is also highly dependent on its proper timing of administration, and patients must be thoroughly educated about this. The impact of symptoms of EPI can lead to poorer overall well-being. Pharmacists play a crucial role in properly educating patients on the correct use of pancreatic enzyme replacement therapy. PERT is a key strategy in managing the symptoms of EPI and can improve quality of life, which is a central focus in palliative care. This treatment is profoundly underutilized in the palliative care of these patients. The objective of this review is to discuss the pharmacology, pharmacokinetics, side effects, available evidence of the effectiveness of pancreatic enzyme use for patients with pancreatic cancer, and challenges, along with proposed solutions regarding its use. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
12 pages, 470 KiB  
Review
A Review of Olanzapine in the Treatment of Cancer Anorexia-Cachexia Syndrome
by Ivy O. Poon, Veronica Ajewole and Ursula K. Braun
Pharmacy 2024, 12(1), 34; https://doi.org/10.3390/pharmacy12010034 - 17 Feb 2024
Viewed by 1703
Abstract
Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the [...] Read more.
Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the American Society of Clinical Oncology (ASCO) released a rapid recommendation suggesting that low-dose olanzapine once daily may be used to treat cancer cachexia. Many questions still exist on how to use olanzapine for this indication in clinical practice. The objective of this review is to identify existing knowledge on the use of olanzapine for CAS. Methods: A comprehensive search was conducted to identify the primary literature that involved olanzapine for anorexia and cachexia in cancer patients between 2000 and 2023. Results: Seven articles were identified and are discussed here, including two randomized double-blinded placebo-controlled studies, one randomized comparative study, two prospective open-label studies, one retrospective chart review, and one case report. Conclusions: Low dose olanzapine (2.5–5 mg once daily) may be useful in the treatment of CAS for increasing appetite, reducing nausea and vomiting, and promoting weight gain. Further large-scale multi-center randomized placebo-controlled studies will be needed to investigate the impact of olanzapine on weight change in CAS patients. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
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Other

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8 pages, 390 KiB  
Brief Report
Evaluation of Peak Inspiratory Flow Rate in Hospitalized Palliative Care Patients with COPD
by Joshua Borris, Heather Cook, Sulgi Chae, Kathryn A. Walker and Mary Lynn McPherson
Pharmacy 2023, 11(4), 113; https://doi.org/10.3390/pharmacy11040113 - 6 Jul 2023
Cited by 1 | Viewed by 2277
Abstract
Dry powder inhalers are an effective yet costly COPD medication-delivery device. Patients must possess a minimum peak inspiratory flow rate (PIFR) for inhaled medication to be properly deposited into the lungs. Hospitalized palliative-care patients with diminished lung function due to advanced COPD may [...] Read more.
Dry powder inhalers are an effective yet costly COPD medication-delivery device. Patients must possess a minimum peak inspiratory flow rate (PIFR) for inhaled medication to be properly deposited into the lungs. Hospitalized palliative-care patients with diminished lung function due to advanced COPD may not possess the minimum PIFR (30 L/min) for adequate drug delivery. This study aims to quantify PIFR values for hospitalized palliative-care patients with advanced COPD to evaluate whether these patients meet the minimum PIFR requirements. Hospitalized patients ≥18 years old with a palliative-care consultation were eligible if they had a diagnosis of advanced COPD (GOLD C or D). Patients were excluded if they lacked decision-making capacity or had a positive COVID-19 test within the previous 90 days. Three PIFR values were recorded utilizing the In-CheckTM device, with the highest of the three PIFR attempts being utilized for statistical analysis. Eighteen patients were enrolled, and the mean of the highest PIFR readings was 72.5 L/min (±29 L/min). Post hoc analysis indicated 99.9% power when comparing the average best PIFR to the minimum PIFR (30 L/min) but only 51.4% power when compared to the optimal PIFR (60 L/min). This study found that palliative-care patients possess the minimum PIFR for DPI drug delivery. Full article
(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)
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