A retrospective single-centre analysis of the prevalence of statin use in geriatric oncology: Is there a role for cessation?

e24016 Background: Statins have become ubiquitous in medicine. There is a myriad of indications, and the duration of treatment required for efficacy is measured in years. There is a need for clarity on their role in geriatric oncology and when to de-prescribe. Within a sample of Irish patients in 1987, 8% would have been eligible for a statin. By 2016, this had climbed to 61%. During this time, the number needed to treat increased from 40 to 400. In terms of benefit, a meta-analysis concluded that 100 patients need treatment for 2.5 years to prevent one major adverse cardiovascular event (MACE) in the primary preventative setting. It is not clear whether this benefit is derived in later life. As a result, the United States preventive service task force concluded that evidence is insufficient to recommend initiating a statin for primary prevention in adults over 75. The aim of our study was to assess the prevalence of statin use in older adults with cancer, and the evidence for de-prescribing. Methods: Data was retrospectively collected from a prospectively maintained database of patients attending the Geriatric Oncology Assessment and Liaision (GOAL) clinic in the South East Cancer Centre, University Hospital Waterford, Ireland. Data collected includes age at cancer diagnosis, stage, co-morbidities, and medications. We determined how many patients were taking statins (or ezetimibe) prior to first oncology review, their indication and overall survival. Indications for statins were categorised using a hierarchy of indications, as described by Wallach Kildemoes et al. Results: 138 of 233 patients were taking statins at the time of their review (59%). The average age at cancer diagnosis was 78.6 years. Seventy-nine were taking statins for primary prevention (58%). 15 of 79 whom had diabetes. Stage 3 or 4 disease accounted for 78% of this group. Overall survival in this group was 1.59 years. Within the group with stage 4 disease (n = 100), 53 were taking a statin. Twenty-eight (52.8%) were for primary prevention. Within this group, 6 had diabetes. Overall survival in this group was 1.44 years. Conclusions: Overall survival of patients was short of the 2.5 years required to provide benefit. Therefore, there is evidence to stop this medication in the primary preventative group, once diagnosed with advanced cancer. The stage 4 disease group included patients undergoing secondary prevention, so treatment is more efficacious. However, with an overall survival of 1.44 years, the window for benefit is small.[Table: see text]