Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea.
Support Care Cancer. 2021 Aug;29(8):4607-4614. doi: 10.1007/s00520-021-06008-z. Epub 2021 Jan 24.
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.
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.
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.
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.
虽然抗胆碱能负担与老年人的不良结局相关已为人所知，但在晚期癌症患者中，其临床重要性研究较少。我们旨在评估在老年癌症患者中使用抗胆碱能药物的临床影响。
这是一项单中心回顾性数据库研究。本研究纳入了年龄在 65 岁或以上、患有 IV 期实体癌并在一家三级医院的住院医生管理的医疗单位住院的患者。我们通过回顾住院期间的所有药物来计算入院时和住院期间的抗胆碱能认知负担（ACB）评分，并收集以下数据：人口统计学、病史和临床严重程度、谵妄的发生、出院地点、院内死亡率和出院后死亡率数据。
当我们根据住院期间 ACB 的变化将患者分为两组时，ACB 增加组的院内死亡率、谵妄发生率、转至长期护理院的频率和住院时间均高于非增加组。即使排除了临床上发现的谵妄患者，ACB 的增加与院内死亡率的增加相关。基于 Cox 比例风险模型，ACB 增加组的患者在出院后的死亡风险高于非增加组。
住院期间 ACB 的增加是老年癌症患者临床特征恶化和死亡率升高的预测指标。需要进一步研究抗胆碱能负担增加与预后不良之间的因果关系。
