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Clinical outcomes associated with anticholinergic burden in older hospitalized patients with advanced cancer: a single-center database study

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Abstract

Purpose

Although anticholinergic burden has been known to be associated with adverse outcomes in older adults, its clinical importance has been less studied in patients with advanced cancer. We aimed to assess clinical impacts of using anticholinergic medications in older patients with cancer.

Methods

This is a single-center retrospective database study. This study included patients with stage IV solid cancer aged 65 years or older who were hospitalized in a hospitalist-operated medical unit of a tertiary hospital. We calculated anticholinergic cognitive burden (ACB) scores on admission and during hospitalization by reviewing all medications during hospital stays and collected the following data: demographic, medical history and clinical severity, occurrence of delirium, location of discharge, in-hospital mortality, and after discharge mortality data.

Results

When we divided the patients into two groups based on the change in ACB during hospitalization, the in-hospital mortality rate, incidence of delirium, frequency of transfers to long-term care hospitals, and length of hospital stay were higher in the ACB-increased group than those in the non-increased group. Even after excluding patients with clinically detected delirium, increased ACB were associated with increased in-hospital mortality. Patients in the ACB-increased group showed higher mortality risk after discharge than those in the non-increased group based on the Cox proportional hazard model.

Conclusion

Increased ACB during hospitalization is a predictor of worsening clinical features and higher mortality in older patients with cancer. Further studies investigating causal relationship between an increased ACB and poor prognosis are warranted.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, Han SJ. The data are not publicly available due to restrictions for the death data received from the Korea Statistics Promotion Institute, which could compromise the privacy of research participants.

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Funding

This study was supported by grant No.0420202070 from the Seoul National University Hospital Research Fund.

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Author notes

  1. Jae Hyun Lee and Jin Lim contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Jae Hyun Lee, Jin Lim, Seung Jun Han, Sung do Moon, Hongran Moon, Seo-Young Lee, Hyeanji Kim & Hee-Won Jung

  2. Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea

    Jae Hyun Lee, Jin Lim, Seung Jun Han, Sung do Moon, Hongran Moon, Seo-Young Lee & Hee-Won Jung

  3. Regional Emergency Medical Center, Seoul National University Hospital, Seoul, South Korea

    Hyeanji Kim

  4. Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Hee-Won Jung

Authors
  1. Jae Hyun Lee
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Contributions

All authors meet the criteria for authorship as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, as well as because of their contributions to the manuscript. Conceptualization: Seung Jun Han; data curation: Jin Lim, Sung do Moon, Hyeanji Kim; formal analysis: Seung Jun Han, Jae Hyun Lee, Jin Lim; funding acquisition: Hee-Won Jung; Methodology: Seung Jun Han, Jae Hyun Lee; supervision: Hee-Won Jung; validation; Hongran Moon, Seo-Young Lee; visualization: Jae Hyun Lee, Hee-Won Jung; writing–original draft: Jae Hyun Lee, Jin Lim; writing–review and editing: Seung Jun Han, Hee-Won Jung.

Corresponding author

Correspondence to Seung Jun Han.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval and consent to participate

This study was carried out in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Seoul National University Hospital (Approval No. H-2006-025-1130). This study waived the need for informed consent because of the retrospective nature of the study.

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Lee, J.H., Lim, J., Han, S.J. et al. Clinical outcomes associated with anticholinergic burden in older hospitalized patients with advanced cancer: a single-center database study. Support Care Cancer 29, 4607–4614 (2021). https://doi.org/10.1007/s00520-021-06008-z

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  • DOI: https://doi.org/10.1007/s00520-021-06008-z

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