Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life

Hochman, MJ; Kamal, AH; Wolf, SP; Samsa, GP; Currow, DC; Abernethy, AP; LeBlanc, TW

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life

Hochman, MJ Kamal, AH Wolf, SP Samsa, GP Currow, DC

Abernethy, AP LeBlanc, TW

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Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2016, 52 (5), pp. 737 - 743.e3
Issue Date:: 2016-11-01

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Field	Value	Language
dc.contributor.author	Hochman, MJ	en_US
dc.contributor.author	Kamal, AH	en_US
dc.contributor.author	Wolf, SP	en_US
dc.contributor.author	Samsa, GP	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Abernethy, AP	en_US
dc.contributor.author	LeBlanc, TW	en_US
dc.date.available	2016-04-27	en_US
dc.date.issued	2016-11-01	en_US
dc.identifier.citation	Journal of Pain and Symptom Management, 2016, 52 (5), pp. 737 - 743.e3	en_US
dc.identifier.issn	0885-3924	en_US
dc.identifier.uri	http://hdl.handle.net/10453/105243
dc.description.abstract	© 2016 American Academy of Hospice and Palliative Medicine Context 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. Objectives To determine ACL and its impact in noncancer versus cancer palliative care patients. Methods 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). Results 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). Conclusions 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.	en_US
dc.relation.ispartof	Journal of Pain and Symptom Management	en_US
dc.relation.isbasedon	10.1016/j.jpainsymman.2016.03.020	en_US
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Neoplasms	en_US
dc.subject.mesh	Fatigue	en_US
dc.subject.mesh	Cholinergic Antagonists	en_US
dc.subject.mesh	Antineoplastic Agents	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Terminal Care	en_US
dc.subject.mesh	Multivariate Analysis	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Odds Ratio	en_US
dc.subject.mesh	Longitudinal Studies	en_US
dc.subject.mesh	Comorbidity	en_US
dc.subject.mesh	Dose-Response Relationship, Drug	en_US
dc.subject.mesh	Quality of Life	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Sleep Wake Disorders	en_US
dc.title	Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	52	en_US
utslib.for	1110 Nursing	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	52	en_US

Abstract:

© 2016 American Academy of Hospice and Palliative Medicine Context 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. Objectives To determine ACL and its impact in noncancer versus cancer palliative care patients. Methods 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). Results 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). Conclusions 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.

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http://hdl.handle.net/10453/105243