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

Abstract

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 non-malignant diseases. Objectives To determine ACL and its impact in non-cancer 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 non-cancer 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 non-cancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P<0.05), however DM drugs exposed non-cancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P<0.0001). ACL was associated with worse fatigue (OR, 1.08; CI, 1.002–1.17) and worse QOL (OR, 0.89; CI, 0.80–0.98). Conclusions ACL is associated with worse fatigue and QOL, and may not differ significantly between cancer and non-cancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and non-cancer patients, though 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.

Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life

“…Furthermore, the majority of older people are exposed to drugs with anticholinergic and/or sedative effects ( 49 ), and resorting to anticholinergics and sedatives to control pain, dyspnea, secretions and patient anxiety, among other symptoms, is common in palliative care ( 50 ). Thus, in our study, most of the anticholinergic and/or sedative drugs prescribed at the EOL are related to drugs for symptomatic use, and their use increased as the patient approached the EOL, which is consistent with previous studies ( 51 , 52 ). This could be due to the increase of DBI during patient follow-up, which could be related to an increase in psychotropic medications for symptom management at EOL.…”

Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index

“…In addition, the comparative analysis of the baseline pharmacotherapeutic characteristics between different degrees of frailty highlighted a higher DBI in those with advanced frailty. This may be related to a situation closer to the EOL, which requires these patients to use more drugs with anticholinergic and sedative characteristics [ 33 , 34 , 35 ]. Notably, greater exposure to drugs with anticholinergic activity is associated with more fatigue, dry mouth, worse concentration, and worsening status at EOL [ 34 ].…”

Anticholinergic Burden in Hospice Patients With Dementia

“…10 Despite documented risks and AGS recommendations, the use of medications with anticholinergic properties remains prevalent in older adults with dementia and in patients near the EOL. 8,11,12 A retrospective study evaluating anticholinergic drug use in over 89 000 patients and its impact on cognitive function found that mean Anticholinergic Cognitive Burden (ACB) scores were highest in patients with dementia. 13 In a similar retrospective analysis of Medicare data, it was found that 77% of nursing home residents with dementia used at least 1 DAP each month and of those residents, 34% used DAPs with an ACB scale of 2 or 3.…”