It was a question that needed an answer. Is it safe to discontinue statins for a patient with less than a year to live? Does the risk outweigh the benefits when medications for optimal management of longstanding medications prescribed for comorbid illness are discontinued?
Findings from a federally funded, randomized study, seems to indicates that it is indeed safe to stop statin therapy in this group of patients. The study results show that discontinuing statins did not shorten survival, and provided a number of important benefits, including reduced pill and symptom burden and an improved overall health related quality of life.[1][2]
?Many doctors argue that, near the end of life, it is not necessary to continue medications for chronic illnesses that are not life-threatening. But we have no guidance on what medicines to stop and when to do so,? said lead study author Amy P. Abernethy, MD, PhD, a medical oncologist and palliative care specialist at Duke University Medical Centerin Durham, NC. ?Our study provides the first evidence that stopping statins is safe and improves patient quality of life.?
Increasing burden
The number of medications patients take doubles in the last year of life for those with terminal illnesses. This means patients are taking 10 or more different pills per day ? a big burden for patients who frequently have difficulty swallowing and poor appetite. An additional problem is that the side effects of each medication accumulate, and new side effects can appear when multiple drugs are taken together. Furthermore, interactions between drugs can reduce the efficacy of individual treatments.
We have evidence that discontinuing certain medications is safe, specifically in the case of the widely prescribed statin drugs, and can improve health related quality of life for patients at the end of their life
Cholesterol-lowering drugs
The study, which was supported by the National Institute of Nursing Research/National Institutes of Health, included 381 
patients with life-limiting illness and a life expectancy of one month to one year, who had been taking a statin for at least three months. The mean age of these patients was 74 years(189 discontinue statins; 192 continue statins; 22% were cognitively impaired; 49% had cancer as the primary diagnosis; and, 69% had used statins for >5 years.
Statins are cholesterol-lowering drugs prescribed to reduce the risk of heart attacks and strokes. The most common side effects of statins are headache, difficulty sleeping, muscle aches, drowsiness, and dizziness. Patients were randomly assigned to either continue or discontinue statin therapy.
Discontinuing is safe
Researchers found that discontinuing statins was safe. Few patients in either group experienced cardiovascular complications (13 in the group that discontinued vs. 11 in the group that continued). The rate of death within 60 days was not significantly different between the two groups (20.3% vs. 23.8%, 90% CI -3.5% to 10.5%, p=0.36), and the group that discontinued statins even had a longer median time-to-death (229 days [90% CI 186?332]vs. 190 days [90% CI 170-257]; p=0.60).
Patients who discontinued statins had a substantially better total health related quality of life (about a 10% improvement on a standard scale: McGill QOL: 7.11 vs. 6.85, p=0.037) and tended to have fewer symptoms. They also took fewer medications overall compared to patients who continued statins (10.1 vs. 10.8;p = 0.034).
Individual basis
The researchers estimates that nearly US$ 603 million would potentially be saved in the United States if all people with a life expectancy of a year or less, similar to the group involved in this study, were to discontinue statins. However, Abernethy noted that discontinuing statins is not appropriate for every patient, and the decision should be made on an individual patient basis.
Discontinuing makes sense
?Discontinuing chronically administered medications near the end of life has only be limitedly studied. No one wants to ?rock the boat? at this stage of life, and continuing medications that have no benefit for prevention of future disease generally makes sense in this situation,? noted Patricia Ganz, MD, FASCO, ASCO Expert and director of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA. ?However, now we have evidence that discontinuing certain medications is safe, specifically in the case of the widely prescribed statin drugs, and can improve health related quality of life for patients.?
For more information
[1] Abernethy AP, Kutner J, Blatchford PJ, Ritchie C, Fairclough D, Hanson L, Bull J, et al. Managing comorbidities in oncology: A multisite randomized controlled trial of continuing versus discontinuing statins in the setting of life-limiting illness. 2014 ASCO Annual Meeting. Clinical Science Symposium. Tuesday June 3, 9:45 AM to 11:15 AM. Abstract No: LBA9514. Citation: J Clin Oncol 32:5s, 2014 (suppl; abstr LBA9514)[Abstract]
[2] NCT01415934 – Statin Discontinuation in Advanced Illness. [Study Record Detail]
Photo: Amy Pickar Abernethy, MD, PhD speaks at the 50th Annual Meeting of the American Society of Clinical Oncology (ASCO). Potho Courtesy: ?ASCO/Scott Morgan.
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