ASCO 2014: Stopping Statins Is Safe and Can Improve Quality of Life for Patients With Cancer Near the End of Life
Stopping statin therapy is safe for patients with cancer who have a life expectancy of less than 1 year, according to a randomized study reported at the 2014 ASCO Annual Meeting in Chicago (Abstract LBA9514). Discontinuing statins did not shorten survival and provided a number of important benefits, including reduced pill and symptom burden and improved overall quality of life.
“The number of pills in our pill cup doubles at the end of life: medicines to treat the illness, medicines for comorbidities that we have been taking for a very long time, and medicines for symptom control and other burdens,” lead study author Amy P. Abernethy, MD, PhD, a medical oncologist and palliative care specialist at Duke University Medical Center in Durham, North Carolina, noted at an ASCO press briefing for patient care and quality of life. “For people with life-threatening illness, the optimal management of these medications, including which ones we can discontinue, is a critical question about which we are uncertain.”
The study aimed to determine whether HMG Co-A reductase inhibitors (statins) were among the drugs that could be safely discontinued by patients with less than a year to live.
No Significant Mortality Differences
“This is a multicenter, unblinded pragmatic trial,” Dr. Abernethy reported. “Patients were randomly assigned to discontinue or continue their statin medications at the time of study entry.” The study included 381 patients with advanced life-limiting illness, 49% with cancer, and a prognosis of ≤ 1 year with evidence of recent deterioration in performance status. Patients were taking statin medications for primary or secondary prevention for ≥ 3 months, and 69% had used statins for > 5 years. The mean age was 74 years, and 22% of patients were cognitively impaired.
The primary outcome was rate of death within 60 days of randomization. Other outcomes measured at baseline and at least monthly included cardiovascular-related events, quality of life, symptoms, and polypharmacy.
Few patients in either group experienced cardiovascular complications, 13 of the 189 people that discontinued statins vs 11 of the 192 people who continued statins. The rate of death within 60 days was not significantly different between the two groups, 20.3% for those who discontinued statins vs 23.8% for those who continued (90% confidence interval [CI] = 3.5%–10.5%, P = .36). The group discontinuing statins had longer median time to death, but it was not statistically significant (229 days [90% CI = 186–332] vs 190 days [90% CI = 170–257]; P = .60).
“Survival is not impacted by discontinuing statins,” Dr. Abernethy stated.
Quality of Life and Cost Factors
The group discontinuing statins had significantly better total quality of life, as measured by the McGill Quality of Life Questionnaire (7.11 vs 6.85, P = .037), and there were fewer symptoms, as measured by the Edmonton Symptom Assessment Scale (25.2 vs 27.4, P = .128). The number of nonstatin medicines significantly decreased for those patients who discontinued statins (10.1 vs 10.8, P = .034), and Dr. Abernethy noted that there was a trend toward improved satisfaction with care.
An estimated $603 million could potentially be saved in the United States in 2014 if all people with a life expectancy of ≤ 1 year, similar to the group involved in this study, were to discontinue statins. This estimate was based on an average survival on the study of 212 days and $3.37 saved per patient per day. Applying these results to a 2040 population estimate, the potential savings would total $1 billion, reported Dr. Abernethy.
Patient-Centered Decision
The clinical question of whether to continue or discontinue statins in the last year of life remains “a patient-centered decision, where clinicians and patients together talk about what to do,” Dr. Abernethy concluded. “However, as s clinicians, we can now feel confident we are not harming the patient by making this decision.”
Many medications that patients take for a long time, such as blood pressure medications and statins, are for prevention, Patricia Ganz, MD, ASCO expert on breast cancer and palliative care, noted. “When someone has a shortened life expectancy, prevention doesn’t really make sense, but we are loath to make those changes. With this simple, pragmatic, randomized controlled trial, we as clinicians can now feel comfortable having discussions with our patients and their families about the fact that stopping these medications—in this case a statin—would not have any adverse outcome and may be beneficial to the patient in the last weeks of life.” Dr. Ganz is Director of Cancer Prevention and Control Research at Jonsson Comprehensive Cancer Center in Los Angeles.
This research was supported by the National Institute of Nursing Research, National Institutes of Health. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
