Delirium in terminal cancer inpatients: short-term survival and missed diagnosis

Abstract

Introduction. Delirium is a neurocognitive disorder, frequently present in advanced cancer patients. It morbidity, mortality, health expenditure, and causes distress to patients, family members, and health care professionals. Despite its impact, the disorder is still underdiagnosed, and consequently, mistreated. Objective. To describe the prevalence, clinical features, impact on the survival and percentage of missed diagnosis of delirium, in palliative care inpatients treated in a tertiary center. Method. We conducted a prospective study, including all the inpatients referred to the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico, from August, 2014 to March, 2015. As a first step, we collected clinical and sociodemographic data, and determined the presence/absence of delirium, using the Confusion Assessment Method. Then, we reviewed the clinical file to determine if a previous delirium diagnosis was stablished by the primary referring team. Finally, thirty days after the initial assessment, we contacted the patients in order to know their survival status (alive/death). We performed a survival analysis to compare mortality among patients with delirium/non-delirium, and reported the percentage of delirium missed diagnosis. Results. We included 174 patients, 40.2% were diagnosed with delirium. Mean survival time in patients with delirium was 11 days, while in non-delirium patient’s mean survival time was 21 days; Log Rank 23.50, p < .001. We found a 73% of missed delirium diagnosis by the primary referring team. Discussion and conclusion. Prevalence of delirium in this population is similar to that observed in other palliative care populations. Also, delirium is the principal determinant of short-term mortality, and it is frequently underdiagnosed. Preventive strategies and early identification could help to reduce its burden.

Effect of Hematocrit Injury on the Survival Rate of Advanced Malignant Tumors and Its Clinical Significance

“…Delirium can be considered as a common syndrome of loss of consciousness in patients with advanced cancer [ 27 , 28 ]. In this study, 20.83% of the patients indicated expectant symptoms on admission, which was similar to the 26.0%~44.0% reported [ 29 ]. Current studies believe that the emergence of delirium is the result of multiple clinical factors, including drugs, electrolyte disorders, endocrine disorders, hypoxemia, infection, paraneoplastic syndrome, intracranial metastasis, and dehydration [ 30 ], although the study reported that through appropriate intervention, the outlook of nearly 50% of patients with advanced cancer is reversible.…”

Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

“…47 Most studies included inpatient specialist palliative care units in hospitals (n = 21) 32,37,39,41,42,44,46,[48][49][50][51][52][53][55][56][57][58][59][60][61][62] or hospice (n = 5). 33,39,47,51,54 Three studies each included palliative care consultation teams 40,45,49 and palliative care community services 33,41,43 In 23 studies, all participants had a primary cancer diagnosis, 32,33,37,[40][41][42][46][47][48][49][50][51][52][53][54][55][56]…”

“…39,45 Participants in 24 studies were in the late stages of illness (e.g. advanced or terminal cancer), 32,33,37,[39][40][41][42][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] while in the remaining four studies participants' stage of illness was unclear. 39,[43][44][45] In 14 studies, only cross-sectional data was eligible for the review.…”

“…37,[39][40][41][42]44,48,[51][52][53][54][55]57,58,61 Many of the studies which conducted multivariate analysis had adjusted for some, but not all, important potential confounding factors. 39,43,[45][46][47]49,50,59,60,62 Several included studies selectively reported results, including six studies which only reported multivariate analysis results that were statistically significant. 39,49,50,56,59,60 Potentially modifiable risk factors.…”

Pharmacological and non-pharmacological treatment of delirium in an oncological hospital service: an integrative review

“…However, despite common, this condition is underdiagnosed in health organizations; authors have stated that the incidence of this syndrome in intensive care units (ICUs) varies from 5% to 92% (6) . A study have suggested that the incidence of these cases in patients with cancer is high, and can reach 80% in more advanced stages of the disease, being related to a worst control of pain and to a diminution of survival rates (7) . In cancer patients, many studies reported associations between delirium, hospital mortality, and post-discharge mortality; in the last months of life, there is an association between its hypoactive and mixed subtypes and a lower survival rate (8) .…”