title: Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study.
abstract: BACKGROUND
  Anti-cholinergic medications have been associated with increased risks of cognitive impairment, premature mortality and increased risk of hospitalisation. Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer, yet little is known about associated adverse outcomes in this setting.
  
  
  METHODS
  A substudy of 112 participants in a randomised control trial who had cancer and an Australia modified Karnofsky Performance Scale (AKPS) score (AKPS) of 60 or above, explored survival and health service utilisation; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale (modified version) longitudinally to death. A standardised starting point for prospectively calculating survival was an AKPS of 60 or above.
  
  
  RESULTS
  Baseline entry to the sub-study was a mean 62 +/- 81 days (median 37, range 1-588) days before death (survival), with mean of 4.8 (median 3, SD 4.18, range 1 - 24) study assessments in this time period. Participants spent 22% of time as an inpatient. There was no significant association between anti-cholinergic score and time spent as an inpatient (adjusted for survival time) (p = 0.94); or survival time.
  
  
  CONCLUSIONS
  No association between anti-cholinergic load and survival or time spent as an inpatient was seen. Future studies need to include cognitively impaired populations where the risks of symptomatic deterioration may be more substantial.
authors.affiliation: Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia. meera.agar@sswahs.nsw.gov.au
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.forename: Timothy
authors.initials: T
authors.lastname: To
authors.forename: John
authors.initials: J
authors.lastname: Plummer
authors.forename: Amy
authors.initials: A
authors.lastname: Abernethy
authors.forename: David
authors.initials: D
authors.lastname: Currow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy*; D010865:Pilot Projects; D016019:Survival Analysis
chemical_list: D018680:Cholinergic Antagonists