Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care

Hamano, Jun; Mori, Masanori; Ozawa, Taketoshi; Sasaki, Jun; Kawahara, Manabu; Nakamura, Asumi; Hashimoto, Kenkichi; Hisajima, Kazuhiro; Koga, Tomoyuki; Goto, Keiji; Fukumoto, Koji; Morimoto, Yuri; Goshima, Masahiro; Sekimoto, Go; Baba, Mika; Oya, Kiyofumi; Matsunuma, Ryo; Azuma, Yoko; Imai, Kyoichi; Morita, Tatsuya; Shinjo, Takuya

doi:10.1002/cam4.3661

Cited by 9 publications

(25 citation statements)

References 33 publications

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“…Based on these findings, Ra-223 was established as a standard treatment modality for mCRPC patients with predominant bone disease and no visceral metastases [ 4 – 6 ]. The approved regimen of Ra-223 is an intravenous injection of 55 kBq/kg of Ra-223, every 4 weeks (q4w), for six cycles [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

et al. 2021

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Purpose We evaluated the predictive factors for completion of all six cycles of radium-223 (Ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). We also developed a novel prediction model for Ra-223 treatment completion using these predictors. Methods We retrospectively reviewed data from 122 patients with mCRPC who were treated with Ra-223. The predictive factors for the completion of six cycles of Ra-223 treatment were evaluated. Statistically significant predictive factors were then used to develop a prediction model for treatment completion. Finally, using this prediction model, we classified the overall survival (OS) of the entire cohort into three groups. Results We identified three significant variables as the predictive factors for treatment completion: baseline alkaline phosphatase (ALP) level, baseline hemoglobin (Hb) level, and baseline pain. The three groups generated using the prediction model were: group 1 (patients with three predictive factors, i.e., ALP < median, Hb ≥ median, and no pain), group 2 (patients with one to two predictive factors), and group 3 (patients without any predictive factors). The treatment completion rates differed between the three groups significantly. Furthermore, the OS also differed among the groups significantly. Conclusion Our study suggested that the baseline ALP level, baseline Hb level, and baseline pain were the predictive factors of completion of all six cycles of Ra-223 treatment in patients with mCRPC. Our prediction model consisting of these factors could predict not only the completion of Ra-223 treatment, but also the post-treatment survival. This model can thus be useful for selection of patients for Ra-223 treatment.

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Section: Introductionmentioning

confidence: 99%

A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

et al. 2021

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Section: Study Characteristicsmentioning

confidence: 99%

“…The characteristics of the nine included studies were presented in Table 1 (9,10,(15)(16)(17)(18)(19)(20)(21). Among these studies, three were case-control studies (9,19,20), and five were cohort studies (10,(15)(16)(17)(18). The studies involved 4,939 subjects (899 delirium cases and 4,040 non-delirious controls) from five countries.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies explored the risk factors for hyperactive delirium only (15,20), while another study investigated risk factors for hyperactive and mixed-type delirium (9). The remaining six studies did not mention the subtype of delirium (10,(17)(18)(19)21).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining six studies did not mention the subtype of delirium (10,(17)(18)(19)21). Six studies reported the mean age of study participants from 64 to 72.9 years (9,10,15,(18)(19)(20). All studies reported gender: 2,718 (55.03%) males, and 2,221 (44.97%) were female.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

et al. 2021

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Objective: Delirium is common and highly distressing for the palliative care population. Until now, no study has systematically reviewed the risk factors of delirium in the palliative care population. Therefore, we performed a systematic review and meta-analysis to evaluate delirium risk factors among individuals receiving palliative care.Methods: We systematically searched PubMed, Medline, Embase, and Cochrane database to identify relevant observational studies from database inception to June 2021. The methodological quality of the eligible studies was assessed by the Newcastle Ottawa Scale. We estimated the pooled adjusted odds ratio (aOR) for individual risk factors using the inverse variance method.Results: Nine studies were included in the review (five prospective cohort studies, three retrospective case-control studies and one retrospective cross-section study). In pooled analyses, older age (aOR: 1.02, 95% CI: 1.01–1.04, I2 = 37%), male sex (aOR:1.80, 95% CI: 1.37–2.36, I2 = 7%), hypoxia (aOR: 0.87, 95% CI: 0.77–0.99, I2 = 0%), dehydration (aOR: 3.22, 95%CI: 1.75–5.94, I2 = 18%), cachexia (aOR:3.40, 95% CI: 1.69–6.85, I2 = 0%), opioid use (aOR: 2.49, 95%CI: 1.39–4.44, I2 = 0%), anticholinergic burden (aOR: 1.18, 95% CI: 1.07–1.30, I2 = 9%) and Eastern Cooperative Oncology Group Performance Status (aOR: 2.54, 95% CI: 1.56–4.14, I2 = 21%) were statistically significantly associated with delirium.Conclusion: The risk factors identified in our review can help to highlight the palliative care population at high risk of delirium. Appropriate strategies should be implemented to prevent delirium and improve the quality of palliative care services.

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Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

Recchia¹,

Rizzi²,

Favero³

et al. 2022

Med Princ Pract

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Objectives: The aim of this study was to assess the prevalence of delirium, using the Assessment Test for Delirium and Cognitive Impairment (4AT) in end-of-life palliative care patients. Subjects and Methods: This retrospective cross-sectional study was conducted in a sample of end-of-life palliative care patients in a hospice or at home. All patients were evaluated with the 4AT for the presence of delirium. Results: Of the 461 patients analyzed, 16.5% (76) were inpatients and 83.5% (385) outpatients. The median age of the whole sample was 79.5 (72-86) years and 51.0% were female. According to the 4AT score 126 patients (27.3%) had delirium (A4T ≥4) at admission, 28 (36.8%) were inpatients and 98 (25.5%) outpatients. Our sample included cancer and non-cancer life-limiting diseases and represents the whole palliative care and end-of-life population of general adult palliative care services in Italy. One third of cancer inpatients (23, 33.8%) had delirium and two third (45, 66.2%) did not. Among cancer outpatients 69 (20.6%) had delirium and 266 (79.4%) did not have. The prevalence of delirium varied according to the setting, clinical condition and life expectancy. According to the 4AT score, 33.8% (23) cancer inpatients and 20.6% (69) outpatients were with delirium. In addition, 55.0% (11) actively dying inpatients, within three days, had delirium and 56.7% (17) outpatients; while among those with life expectancy longer than 4 days, 30.4% (17) inpatients and 22.8% (81) outpatient were with delirium. Conclusions: Our study confirms that delirium is common in cancer and non-cancer palliative care patients. . Further research on delirium in end-of-life palliative care patients should consider the complexity of palliative care of this population as well as of the setting’s characteristics.

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Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 9 publications

References 33 publications

A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

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