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

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.

Automated summary

Although the association between anticholinergic burden and adverse outcomes in older adults is known, its clinical importance in patients with advanced cancer is less studied. This study aimed to evaluate the clinical impacts of using anticholinergic medications in older patients with cancer. The results showed that increased anticholinergic burden during hospitalization is a predictor of worsening clinical features and higher mortality in older patients with cancer. Further studies investigating the causal relationship between increased anticholinergic burden and poor prognosis are warranted.