Current Status of Drug Prescribing among Older Adults with Advanced-stage Cancer Receiving Home Medical Care in Japan: A Nationwide Study.

Introduction: Balancing preventive and symptomatic medications is crucial to minimizing polypharmacy in older adults with limited life expectancy. This study examined end-of-life medications among older adults with advanced-stage cancer receiving home medical care. Methods: We conducted a retrospective cohort study using Japan's national claims database between October 2017 and September 2019 and selected adults aged ≥75 years who received comprehensive home medical care services for patients with advanced-stage cancer. We compared prescriptions for preventive and symptomatic medications during two periods: (1) within 180 days before the first claim for the service issued (index date) and (2) within 180 days after the index date or until death. Results: Overall, the study included 8,463 participants, of whom 47% were women and 46% were aged ≥85 years. The median observation period after the index date was 57 days (interquartile range: 30-131 days). Among preventive drugs, antihypertensives were the most frequently prescribed before the index date (60.3%), followed by lipid-lowering drugs (25.4%) and antiplatelets (21.7%). Prescription of lipid-lowering drugs, vitamins, and drugs for osteoporosis decreased by approximately 70%-80% after the index date. In contrast, prescription of oral anticoagulants, antidiabetic drugs, and antidementia drugs declined by approximately 40%. Symptomatic drug prescriptions also decreased after the index date, except for opioids (from 42.2% to 51.9%). Conclusions: This is the first nationwide study to examine the prescriptions of preventive and symptomatic drugs among older adults with advanced-stage cancer receiving end-of-life home medical care.