Prescription Patterns in Terminal Cancer Patients: A Prospective Study in a Low- and Middle-Income Country Setting

Objectives: The objective of the study is to evaluate prescription patterns from admission (Ta) to discharge/death (Td), assess associations between symptom burden and medication use and identify significant co-prescription patterns contributing to polypharmacy. Materials and Methods: A prospective observational cohort study was conducted in an acute palliative care unit of a tertiary cancer hospital (n = 219). Medications were categorised using the World Health Organization anatomical therapeutic chemical codes. Symptom burden was assessed at Ta using the Symptom Assessment Scale. McNemar and Chi-square tests examined changes in prescribing; Pearson correlation assessed relationships between symptom burden and medication use. Results: Polypharmacy was common (mean ~7.5 medications) throughout admission. Opioids (73%), antacids (68%), laxatives (48.9%) and corticosteroids (48.9%) were most frequent at Td. Significant co-prescription patterns included prophylactic combinations (opioid-laxative, corticosteroid-antiulcer, non steroidal anti-inflammatory drugs–antiulcer; p < 0.05), symptom cluster management (opioid-anxiolytic, opioid-propulsives; p < 0.001) and potential medication-induced prescribing patterns (gabapentinoid-diuretic; p = 0.035). Individual symptoms predicted the use of relevant medication classes, but overall symptom burden did not predict total medication load at Td (r = 0.056, p = 0.408), indicating cascade-driven rather than symptom-driven polypharmacy. Only 63.6% of medications aligned with the International Association of Hospice and Palliative Care Essential Medicines List. Conclusion: Persistent polypharmacy and identifiable preventive co-prescribing patterns suggest opportunities for targeted interventions, including structured deprescribing, pharmacist-led reviews and development of LMIC-specific essential medicines lists.