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Characterizing Benzodiazepine Use in Ambulatory Palliative Care Patients Living with Cancer

Characterizing Benzodiazepine Use in Ambulatory Palliative Care Patients Living with Cancer. Courtney Cobert, Amy Dunleavy, Tiffany Khachikian, and Meghal Patel Faculty Adviser: Dr. Kashelle Lockman. Outline. Why Is This Important?.

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Characterizing Benzodiazepine Use in Ambulatory Palliative Care Patients Living with Cancer

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  1. Characterizing Benzodiazepine Use in Ambulatory Palliative Care Patients Living with Cancer Courtney Cobert, Amy Dunleavy, Tiffany Khachikian, and Meghal Patel Faculty Adviser: Dr. Kashelle Lockman

  2. Outline

  3. Why Is This Important? Bachhuber M, et al. American Journal of Public Health 2016; Vol 106, No. 4, pp. 686-688

  4. Why Is This Important? Bachhuber M, et al. American Journal of Public Health 2016; Vol 106, No. 4, pp. 686-688

  5. 2016: FDA BBW: BZDs + opioids • Extreme sleepiness • Respiratory depression • Coma • Death Why Is This Important?

  6. Why Is This Important?

  7. Methods A retrospective, single chart review

  8. MethodsDemographic Data Collection • Palliative Performance Scale • (PPS)

  9. 100% Most Active Patient Palliative Performance Scale (PPS) 70% Reduced Ambulation 50% Mainly sitting 30% Bed Bound 0% Death https://www.vnsny.org/wp-content/uploads/2016/08/VNSNY-Palliative-Performance-Scale-PPS.pdf

  10. Data CollectedRisk factors for BZD induced respiratory depression

  11. Prevalence of Cancer Diagnosis, n = 114 Results

  12. Prevalence of BZD Prescription in Patients with a Cancer Diagnosis, n = 93 Results

  13. Prevalence of BZD Prescription, n = 93 Results

  14. Number of Patients Prescribed BZD by Age n = 58 Results

  15. ResultsIndications n=58

  16. Prevalence of Concomitant Respiratory Depressant Medications, n=58 ResultsCo-Prescribing

  17. Type of BZD Use; n =58 ResultsBenzodiazepine scheduling frequency

  18. BZD Use by Palliative Performance Scale; n = 58 ResultsPPS

  19. DiscussionSimilar Studies Haider A. et al.(S762) J Pain Symp Manage. 2018; 55(2): 690 – 691. Henderson M. et al. Palliat Med. 2006;20(4):407-12.

  20. DiscussionIndication Bachhuber M, et al. American Journal of Public Health 2016; Vol 106, No. 4, pp. 686-688 Henderson M. et al. Palliat Med. 2006;20(4):407-12.

  21. DiscussionGeneral Population Bachhuber M, et al. American Journal of Public Health 2016; Vol 106, No. 4, pp. 686-688 Venkata HG, et al. BMJ 2017;356:j76

  22. DiscussionLimitations

  23. Where do we go from here?

  24. High prevalence of benzodiazepine prescribing in cancer patients • Additional co-prescribing leads to increased risk of respiratory depression and death • Effects of these medications need to be considered when developing patient therapy plans Summary

  25. Questions

  26. Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013. Am J Public Health. 2016;106(4):686-688. doi:10.2105/AJPH.2016.303061 • Haider A, Azhar A, Naqvi S, et al. Concurrent Use of Opioids and Benzodiazepines or Non-Benzodiazepines Sedative Hypnotics Among Cancer Patients Referred to Outpatient Palliative Care Clinic of a Comprehensive Cancer Care Center (S762). J Pain Symptom Manage. 2018;55(2):690-691. doi:10.1016/j.jpainsymman.2017.12.416 • Henderson M, MacGregor E, Sykes N, Hotopf M. The use of benzodiazepines in palliative care. Palliat Med. 2006;20(4):407-412. doi:10.1191/0269216306pm1151oa • Journal of Public Health: April 2016, Vol. 106, No. 4, pp. 686-688. doi: 10.2105/AJPH.2016.303061 • Venkata HG, Chauhan G, Ram BS. Co-prescription of Opioids and Benzodiazepines. BMJ. 2017;356(7). doi:10.1136/bmj.j760 Sources

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