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Missed opportunities : unnecessary medicine use in patients with lung cancer at the end of life : an international cohort study.

Todd, Adam and Al-Khafaji, Jaafar and Akhter, Nasima and Kasim, Adetayo and Quibell, Rachel and Merriman, Kelly and Holmes, Holly (2018) 'Missed opportunities : unnecessary medicine use in patients with lung cancer at the end of life : an international cohort study.', British journal of clinical pharmacology., 84 (12). pp. 2802-2810.


Aims The aims of the current study were: (i) to examine the prescribing of preventative medication in a cohort of people with advanced lung cancer on hospital admission and discharge across different healthcare systems; and (ii) to explore the factors that influence preventative medication prescribing at hospital discharge. Methods A retrospective cohort study was conducted across two centres in the UK and the US. The prescribing of preventative medication was examined at hospital admission and discharge for patients who died of lung cancer. A zero‐inflated negative binomial regression model was used to examine the association between preventative medications at discharge and patient‐ and hospital‐based factors. The classes of preventative medication prescribed included were: vitamins and minerals, and antidiabetic, antihypertensive, antihyperlipidaemic and antiplatelet medications. Results In the UK site (n = 125), the mean number of preventative medications prescribed was 1.9 [standard deviation (SD) 1.7) on admission, and 1.7 (SD 1.7) on discharge, and in the US site (n = 191) the mean was 2.6 (SD 2.2) on admission and 1.9 (SD 2.2) on discharge. The model found a significant association between the number of preventative drugs prescribed on admission and the number on discharge; it also found a significant association between the total number of drugs prescribed on discharge and the number of preventative medications on discharge. Other indicators related to patient and hospital factors were not significantly associated with the number of preventative medications supplied on discharge. Conclusions The use of preventative medication was common in lung cancer patients, despite undergoing discharge. Patient‐ and hospital‐based factors did not influence the prescribing of preventative medication.

Item Type:Article
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Publisher statement:This is the accepted version of the following article: Todd, Adam, Al-Khafaji, Jaafar, Akhter, Nasima, Kasim, Adetayo, Quibell, Rachel, Merriman, Kelly & Holmes, Holly (2018). Missed opportunities: unnecessary medicine use in patients with lung cancer at the end of life: an international cohort study. British Journal of Clinical Pharmacology 84(12): 2802-2810, which has been published in final form at This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Date accepted:30 August 2018
Date deposited:24 September 2018
Date of first online publication:22 September 2018
Date first made open access:22 March 2019

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