Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life.
Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases.



To determine ACL and its impact in noncancer versus cancer palliative care patients.



We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM).



Overall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002-1.17) and worse QOL (odds ratio, 0.89; CI, 0.80-0.98).



ACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.
Duke University School of Medicine, Durham, North Carolina, USA.
Michael J
MJ
Hochman
Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Arif H
AH
Kamal
Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
Steven P
SP
Wolf
Duke Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
Greg P
GP
Samsa
Discipline, Palliative and Supportive Services and Department of Medicine, Flinders University, Adelaide, South Australia, Australia.
David C
DC
Currow
Flatiron Health, New York, New York, USA.
Amy P
AP
Abernethy
Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: thomas.leblanc@duke.edu.
Thomas W
TW
LeBlanc
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D016017:Odds Ratio; D010166:Palliative Care; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology; D013727:Terminal Care
D000970:Antineoplastic Agents; D018680:Cholinergic Antagonists
Cholinergic antagonists; comorbidity; functional status; palliative care; quality of life
J Oncol Pract. 2014 Sep;10(5):e335-41
25118208
Arch Intern Med. 2001 Apr 23;161(8):1099-105
11322844
J Palliat Med. 2015 Jun;18(6):542-4
25789759
J Palliat Med. 2007 Apr;10(2):345-51
17472505
BMC Palliat Care. 2005 Nov 12;4:7
16283937
BMC Geriatr. 2015 Mar 25;15:31
25879993
JAMA. 2000 Nov 15;284(19):2476-82
11074777
Palliat Med. 2009 Apr;23(3):257-65
19318461
Support Care Cancer. 2015 Apr;23(4):913-8
25228018
JAMA Intern Med. 2015 May;175(5):827-34
25798731
JAMA Intern Med. 2015 May;175(5):691-700
25798575
Eur J Clin Pharmacol. 2013 Jul;69(7):1485-96
23529548
J Palliat Care. 1991 Summer;7(2):6-9
1714502
J Am Geriatr Soc. 2007 Apr;55(4):590-5
17397439
Eur J Cancer. 2011 Oct;47(15):2341-6
21798736
J Clin Pharmacol. 2006 Dec;46(12):1481-6
17101747
J Pain Symptom Manage. 2009 Jun;37(6):965-72
19232892
J Palliat Med. 2013 Jan;16(1):38-43
23234300
JAMA Intern Med. 2015 Mar;175(3):401-7
25621434
Basic Clin Pharmacol Toxicol. 2014 Feb;114(2):151-9
24112192
Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl 2:S111-5
20960005
Lancet Oncol. 2015 Jul;16(7):e333-41
26149885
Aust Fam Physician. 2014 Jan-Feb;43(1):29-32
24563890
Palliat Med. 1995 Jul;9(3):207-19
7582177
J R Soc Med. 2000 Sep;93(9):457-62
11089480