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April 1, 2015
Ending Statins in Terminally Ill Improves Quality of Life Without Harm
Aurora, CO—Many patients at the end of life still take statins and other drugs to prevent bad outcomes they are unlikely to live long enough to experience. A new study, published recently in JAMA Internal Medicine, suggests that discontinuing statin use in patients with late-stage cancer and other terminal illnesses may help improve patients’ quality of life without causing other adverse health effects. In fact, researchers at the University of Colorado Anschutz Medical Campus and Duke University found that discontinuing some primarily preventive therapies actually improves care for patients with advanced illness. “There is an increasing evidence base that discontinuation of some therapies may be beneficial for selected patient populations,” the authors write. The issue comes up often because statins are among the most commonly prescribed medications in the United States, with more than 25% of the nation’s Medicare beneficiaries receiving them, according to background information in the article. It also notes that the number of medications at the end of life increases an average of 50%. The multicenter study, conducted from June 2011 to May 2013, enrolled patients who had life expectancy between 1 month and 1 year, showed recent deterioration in function status and had received statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease but had no recent active cardiovascular disease. The average age of the study group was 74, and nearly 50% had cancer. About half of the 381 patients discontinued statins, while the other half continued the therapy. With a median survival time for the entire study population of 219 days, the percentage of participants who died within 60 days was not significantly different between the two groups. “If the results we report—improved quality of life, no significant differences in mortality, and modest cost savings—had been produced by a randomized clinical trial of a new drug in patients with advanced life-limiting illness, the trial would be heralded as a breakthrough and there would be discussion of how to speed access to this new drug,” the authors write. “The same energy needs to be applied to determining when it is appropriate for physicians to discuss discontinuing statin therapy with their patients.” The authors recommend that healthcare professionals discuss the uncertain benefits and possible harm of continuing statin therapy for patients near the end of their lives and with functional decline. “For patients with shorter life expectancy, greater concern about pill burden, and more comfort-oriented goals of care,” the authors conclude, “physicians may endorse discontinuing statins as a means to reduce the number of medications without apparent harmful effects on survival or quality of life.” In an invited commentary, Holly M. Holmes, MD, MS, of the University of Texas MD Anderson Cancer Center in Houston and Adam Todd, PhD, MPharm, of the School of Medicine at Durham University in Durham, England, note that the study’s results “may provide reassurance to patients or caregivers and their clinicians who are considering stopping statin therapy that doing so may not incur harm in the setting of advanced illness and limited life expectancy.” The commentators add, “Patients’ preferences are particularly important, further highlighted by the fact that among the patients eligible for the study who did not enroll, 56.1% were unwilling to participate. Perhaps one of the first steps to deprescribing a statin should be to determine whether a patient has any interest in stopping the medication.” |
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