Discontinuing statin use in patients with late-stage cancer or other terminal illnesses isn’t harmful and may help improve patients’ quality of life, according to new research.
Data presented today at the American Society for Clinical Oncology’s annual meeting in Chicago show that ending statin use in patients with advanced diseases appears to offer several benefits. The study’s lead author, Jean Kutner, MD, MSPH, of the University of Colorado Cancer Center in Aurora, called research on when to stop preventive medications “a new line of investigation.”
Statins are among the most prescribed medications for their ability to lower cholesterol and reduce the risk of heart attack and stroke. About 40% of the drugs are prescribed to prevent a first heart attack or stroke and often patients take them for the rest of their lives.
Kutner and her colleagues with the Palliative Care Research Cooperative Group, which includes more than 20 US member institutions, enrolled 381 patients whose estimated life expectancy was 7 months. About half had cancer and all had taken a statin for at least 3 months. Two-thirds of the patients had taken a statin for more than 5 years.
Half of the patients were randomized to continue the drug, and the other half to stop taking it. Patients were monitored for up to a year to track cardiovascular events, changes in quality of life, and survival.
Death rates within 60 days were similar in both groups, about 20%. Rates of cardiovascular events were approximately 6% in each group. Median survival was 190 days among patients who continued taking a statin compared with 229 days among those who stopped the drug. Patients who quit statins had significant improvements in quality of life, especially in feelings of well-being and support. Stopping the drug also saves money.
Whether or when to stop preventive medications is an important issue in end-of-life care, the investigators noted. Some patients may start anticancer drugs or opioids for pain, increasing the risk of adverse events as their medications accumulate.
Kutner advised that patients with a life expectancy of less than 1 year who take a statin but haven’t recently had a heart attack or stroke talk with their physician about stopping the drug.
“One thing we found during the study was clinicians saying, ‘Hey, I never thought about stopping people’s statins,’ ” Kutner said in a statement. “Here’s a setting in which these drugs may not be doing most patients any good any more, and bringing up the subject of stopping unneeded medications offers the opportunity for shared decision making.”
Medications to prevent osteoporosis, blood clots, high blood pressure, and diabetes are candidates for future studies, Kutner added.