Observational studyJournal of pain and symptom management2017
Off-Label Medication Use in the Inpatient Palliative Care Unit.
Observational study in Journal of pain and symptom management, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Guideline for Medication Management of Distressing Symptoms in Older Patients Receiving End-of-Life Palliative Care.Journal of evidence-based medicine · 2026Guideline
- Motivations and experiences of patients with respiratory disease and their caregivers in a multinational trial of mirtazapine for severe breathlessness: a qualitative study (BETTER-B).BMC pulmonary medicine · 2025Trial
- Current evidence of randomized clinical trials on hospice-eligible patients with agitation and dementia: A narrative review.Palliative & supportive care · 2025Review
- Intravenous haloperidol or chlorpromazine-which is more effective to improve agitation and communication in agitated delirium at the end of life?The oncologist · 2025Article
- Recent advances in understanding the role of antidepressants to manage breathlessness in supportive and palliative care.Current opinion in supportive and palliative care · 2025Review
- Off-label drug use in palliative medicine: Delphi study for the consensus of evidence-based treatment recommendations.Palliative medicine · 2025Article
- Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center.Children (Basel, Switzerland) · 2024Article
- Hospice agency characteristics associated with benzodiazepine and antipsychotic prescribing.Journal of the American Geriatrics Society · 2023Article
- Off-label use in adult palliative care - more common than expected. A retrospective chart review.European journal of hospital pharmacy : science and practice · 2022Article
- Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies.Journal of general internal medicine · 2022Article
- Off-label use of inhaled bronchodilators in hospitalised patients in Spain: a multicentre observational study.European journal of hospital pharmacy : science and practice · 2021Observational
- Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review.Exploratory research in clinical and social pharmacy · 2021Article
- Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.Journal of the American Geriatrics Society · 2021Article
- [Clinical pharmacists in palliative care: effects on drug therapy and drug expenses].Schmerz (Berlin, Germany) · 2019Article
- Off-label drugs use in pediatric palliative care.Italian journal of pediatrics · 2018Article
- Palliative Care in Drug Resistance Tuberculosis: An Overlooked Component in Management.Indian journal of palliative careReview
- Physician-pharmacist agreement about off-label use of medications in private clinical settings in Baghdad, Iraq.Pharmacy practiceArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 2 countries.
Funding
Abstract
contextAlthough off-label medications are frequently prescribed in palliative care, there are no published studies examining their use in the U.S.
objectivesWe examined the frequency of off-label medication use in cancer patients admitted to an acute palliative care unit (APCU).
methodsThis prospective observational study enrolled consecutive patients with advanced cancer admitted to the APCU of a tertiary care cancer center. We collected data on all prescription events, including indications for use, from admission to discharge. Off-label use was checked against the U.S. Food and Drug Administration-approved indications.
resultsAmong the 201 patients, median survival was 10 days (95% CI 7-13), and 85 (42%) patients died in the APCU. We documented 6276 prescription events, and 2199 (35%) were off-label. Among off-label prescriptions, central nervous system agents (n = 1606, 73%), hormones and synthetic substitutes (n = 302, 14%), and autonomic drugs (n = 183, 8%) were most commonly prescribed. Haloperidol (n = 720, 33%), chlorpromazine (n = 292, 13%), dexamethasone (n = 280, 13%), glycopyrrolate (n = 175, 8%), hydromorphone (n = 161, 7%), and morphine (n = 156, 7%) were most frequently prescribed off-label. The most common indications for off-label prescribing were delirium (n = 783, 36%) and dyspnea (n = 449, 20%). Seventy percent of all off-label prescription events had strong evidence supporting use, and 19% of prescription events had moderate or weak evidence for use.
conclusionOne-third of prescription events in the APCU were off-label, with majority of off-label use having a strong level of supporting evidence. Our findings highlight the need for more research in key areas such as delirium and dyspnea management.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.