Medication prescription patterns in cancer rehabilitation physiatry outpatients: A multicenter retrospective study

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BACKGROUND AND OBJECTIVE: Previous work from this dataset found 45% prescribing frequency of any medications (35.1%, 33.5%, and 56.8% at institutions 1, 2, and 3 respectively), without significant difference between in-person and telemedicine. The current study examines medication prescription patterns in greater depth by type of medications. DESIGN: Multicenter retrospective study. SETTING: Three academic medical centers in the United States. PARTICIPANTS: Patients with cancer or history of cancer. INTERVENTIONS: Cancer rehabilitation physiatry outpatient visits. MAIN OUTCOME MEASURES: Frequency of medication types prescribed. RESULTS: A total of 1234 unique patients underwent 3006 visits (institutions 1, 2, and 3 with 614, 1638, and 754 visits, respectively). Most frequently prescribed medication types (percentage of total encounters followed by 95% confidence interval) included opioids (14.5%; 8.1%-21.1%), membrane stabilizers (11.3.%; 5.2%-17.3%), topical agents (8.7%; 2.7%-14.7%), antidepressants (8.3%; 5%-11.8%), muscle relaxants (5%; 1.8%-8.2%), analgesics (nonsteroidal anti-inflammatory agents or acetaminophen) (3.7%; 3.4%-4.1%), and injected agents (5%;1.7%-8.3%). Less frequent categories included bowel medications (2.4%; 0.9%-3.9%), benzodiazepines (2.6%; 0.7%-4.5%), antiemetics (1.8%; 0.3%-3.3%), antibiotics (0.7%; 0.4%-1.0%), sleep aids (1%; 0.5%-1.5%), antipsychotics (1%; 0.1-1.2%), oral corticosteroids (0.5%; 0.3%-0.7%), and cognitive medications (0.6%; 0.2%-1%). Other medications were prescribed in 9.2% (3.5%-14.9%) of encounters. Interinstitutional differences were seen for all medication categories (p < .001), except for nonopioid analgesics (p = .640), antibiotics (p = .4), and corticosteroids (p = .337). CONCLUSION: Treating pain appears to be a predominant but not sole focus of medication prescription in this population. Results illuminate prescribing trends seen in actual practice and may serve to inform individual cancer rehabilitation physiatrist practice, as well as to provide insight into possible directions for future research, such as focusing on frequently prescribed medications in controlled trials, and further examination of "other" medications, which were prescribed at a higher frequency than anticipated. Limitations include that factors underlying the observations could not be determined, including overall acuity; cancer type, stage, or phase; probable impact of differences in dispensation of refills depending on medication type; variability in clinically intended purposes of medications for specific cases; and possible regulatory or institution-specific contexts.

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