Expect Questions but Not a Lot of Resistance

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Stopping statin therapy is safe for patients with cancer who have a life expectancy of no more than a year, according to a randomized study reported at the 2014 ASCO Annual Meeting. Discontinuing statins did not shorten survival, reduced symptom burden, improved overall quality of life, and led many patients to discontinue other medicines as well.

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,” noted the study’s lead author, Amy P. Abernethy, MD, PhD, Professor of Medicine and Palliative Care Specialist at Duke University Medical Center in Durham, North Carolina. “As clinicians, however, we can now feel confident we are not harming the patient by making this decision.”

‘Safe Language’

“Physicians get anxious about having this conversation,” about discontinuing medications for patients at the end of life, Dr. Abernethy told The ASCO Post. But a survey conducted before patients in the study were randomly assigned found that most patients would not interpret negatively a physician’s recommendation to discontinue statins. Less than 5% of patients surveyed said a recommendation to discontinue statins would signify their physician giving up on them, and only 11% were worried about unintended consequences of stopping statins.

“I always try to think about what is safe language for a conversation with a patient,” Dr. Abernethy said. “A good way to bring this up with patients is around the burden of taking so many pills.” Working in partnership, the physician and patient can discuss the medicines the patient is currently taking, and the physician can suggest, “let’s take a look at your list and see what we can do differently.” ■

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