Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study

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Date
2010-07-02
Authors
Agar, Meera Ruth
To, Timothy H M
Plummer, John Lewis
Abernethy, Amy Pickar
Currow, David Christopher
Journal Title
Journal ISSN
Volume Title
Publisher
Mary Ann Liebert, Inc.
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(C) Mary Ann Liebert, Inc. 2010
Abstract
Introduction: 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. Discussion: 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.
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Keywords
Palliative care
Citation
Agar, M.R., To, T.H.M., Plummer, J., Abernethy, A.P. and Currow, D.C., 2010. Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study. Journal of Palliative Medicine, 13(6), 745-752.