Abstract
Introduction
Olanzapine is commonly used in oncology and palliative care to manage chemotherapyinduced nausea and vomiting (CINV), cancer-related anorexia, insomnia, and anxiety. As more patients transition into long-term survivorship, medications started during active treatment may continue well beyond their original purpose. With olanzapine, prolonged exposure can increase the risk of weight gain, dyslipidemia, insulin resistance, and other metabolic complications. Despite its frequent use, clinicians have limited guidance on when and how to deprescribe olanzapine in cancer survivors.Case presentation
We describe two cancer survivors who received long-term olanzapine in a supportive care clinic. The first patient, a woman in her 30s with metastatic neuroendocrine carcinoma of the cervix, had taken olanzapine for nearly two years for insomnia and anxiety. Concerns about obesity, prediabetes, and dyslipidemia led to discontinuation and trials of alternative therapies, along with substantial intentional weight loss. However, persistent insomnia despite multiple alternatives ultimately led to re-initiation of olanzapine after a shared discussion of risks and benefits. The second patient, a woman in her 20's with Hodgkin lymphoma in remission, remained on olanzapine after treatment-related anorexia and insomnia had resolved. She completed a gradual taper without recurrence of symptoms and later showed improvement in her weight trajectory.Discussion
These cases show how nuanced decisions about symptom-directed medications can become during survivorship. Olanzapine may provide meaningful relief during active cancer treatment, but prolonged use can contribute to obesity, dyslipidemia, insulin resistance, and metabolic syndrome. For some patients, deprescribing may reduce long-term metabolic risk without compromising symptom control. For others, ongoing benefit may justify continued or renewed treatment when symptoms remain clinically significant.Conclusion
Olanzapine therapy should be reviewed regularly as patients move beyond active cancer treatment. Decisions to continue, taper, discontinue, or restart therapy should be individualized and should balance current symptom burden, patient priorities, and the potential for long-term metabolic harm.