Deprescribing After Long-Term Cancer Survivorship: A PCP's Worksheet
A structured deprescribing worksheet for long-term survivors carrying years of PRNs — stop/taper logic, contraindication reminders, and how to document the conversation.
By year five, many cancer survivors are carrying a stack of PRNs — anti-nausea, sleep aids, neuropathic pain agents, PPIs, benzodiazepines — that were entirely appropriate at diagnosis and are now the biggest source of adverse-event risk in the chart. This is a structured worksheet for the deprescribing conversation.
The five buckets to walk through
Antiemetics (ondansetron, prochlorperazine), sleep and anxiolytics (benzodiazepines, Z-drugs), neuropathic-pain agents (gabapentin, pregabalin, duloxetine), acid suppression (PPIs), and steroids (topical, inhaled, or oral tapers that never fully stopped). Each has a well-described taper pattern; each has a specific harm profile that intensifies with age.
Stop / taper / continue logic
For each medication: is the indication still active (symptom logged this quarter)? If not, taper. Is the harm profile rising (falls, fractures, cognitive impairment, C. diff risk on chronic PPI)? Prefer taper over continue. Is the patient using it at a lower dose than prescribed? Codify the actual dose in the chart — a paper prescription that no one is taking still shows up in every reconciliation.
Contraindication reminders that matter
Benzodiazepine + opioid — Black Box, additive respiratory depression. Duloxetine + tramadol — serotonin syndrome risk. Gabapentin + opioid — respiratory depression in older adults. Chronic PPI + clopidogrel — CYP2C19 interaction. Flag these in the worksheet so the taper conversation catches them before the pharmacy does.
Document the conversation
A short, structured note — indication reviewed, harm profile discussed, patient goal, taper plan, follow-up interval — protects both the patient and the clinician if a symptom recurs. Life Spark's deprescribing worksheet outputs this note shape directly so it can be pasted into your EHR.