HHS Public Access Author manuscript Author Manuscript
J Pain Symptom Manage. Author manuscript; available in PMC 2017 June 15. Published in final edited form as: J Pain Symptom Manage. 2016 November ; 52(5): 737–743.e3. doi:10.1016/j.jpainsymman.2016.03.020.
Anticholinergic drug burden in non-cancer vs. cancer patients near the end of life Michael J. Hochman, B.S.1, Arif H. Kamal, M.D., M.H.S.2,3, Steven Wolf, M.S.4, Greg P. Samsa, Ph.D.4, David C. Currow, M.P.H., FRACP5, Amy P. Abernethy, M.D., Ph.D.3, and Thomas W. LeBlanc, M.D., M.A.2,6
Author Manuscript
1Duke
University School of Medicine, Durham, NC 27710
2Duke
Cancer Institute, Duke University School of Medicine, Durham, NC 27710
3Flatiron
Health, New York, NY 10012
4Duke
Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710
5Discipline,
Palliative and Supportive Services and Department of Medicine, Flinders University, Adelaide, South Australia 6Division
of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC 27710
Author Manuscript
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.
Author Manuscript
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).
Corresponding Author: Thomas LeBlanc, Box 2715, Duke University Medical Center, Durham, NC 27710, [email protected]. Disclosures Funding for the statin discontinuation study that generated the data for this analysis was provided by the National Institute of Nursing Research (grant numbers UC4-NR012584 and U24-NR014637). This work also included the support of facilities and resources of the Veterans Affairs Health Care System (eg, Phoenix, Arizona, and Birmingham, Alabama). Dr. LeBlanc received funding support from a Junior Career Development Grant from the National Palliative Care Research Center during the time that this analysis was done. He currently receives support from a Sojourns Scholar Award Grant from the Cambia Health Foundation. The design, conduct, analysis, and write-up of the study were performed independently from any sponsoring agency or funding. No other authors have relevant conflicts of interest to report.
Hochman et al.
Page 2
Author Manuscript
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
J Pain Symptom Manage. Author manuscript; available in PMC 2017 June 15. Published in final edited form as: J Pain Symptom Manage. 2016 November ; 52(5): 737–743.e3. doi:10.1016/j.jpainsymman.2016.03.020.
Anticholinergic drug burden in non-cancer vs. cancer patients near the end of life Michael J. Hochman, B.S.1, Arif H. Kamal, M.D., M.H.S.2,3, Steven Wolf, M.S.4, Greg P. Samsa, Ph.D.4, David C. Currow, M.P.H., FRACP5, Amy P. Abernethy, M.D., Ph.D.3, and Thomas W. LeBlanc, M.D., M.A.2,6
Author Manuscript
1Duke
University School of Medicine, Durham, NC 27710
2Duke
Cancer Institute, Duke University School of Medicine, Durham, NC 27710
3Flatiron
Health, New York, NY 10012
4Duke
Biostatistics Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710
5Discipline,
Palliative and Supportive Services and Department of Medicine, Flinders University, Adelaide, South Australia 6Division
of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC 27710
Author Manuscript
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.
Author Manuscript
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).
Corresponding Author: Thomas LeBlanc, Box 2715, Duke University Medical Center, Durham, NC 27710, [email protected]. Disclosures Funding for the statin discontinuation study that generated the data for this analysis was provided by the National Institute of Nursing Research (grant numbers UC4-NR012584 and U24-NR014637). This work also included the support of facilities and resources of the Veterans Affairs Health Care System (eg, Phoenix, Arizona, and Birmingham, Alabama). Dr. LeBlanc received funding support from a Junior Career Development Grant from the National Palliative Care Research Center during the time that this analysis was done. He currently receives support from a Sojourns Scholar Award Grant from the Cambia Health Foundation. The design, conduct, analysis, and write-up of the study were performed independently from any sponsoring agency or funding. No other authors have relevant conflicts of interest to report.
Hochman et al.
Page 2
Author Manuscript
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
