Prevalence of Extrapyramidal Symptoms in Cancer Patients Referred to Palliative Care: A Multicenter Observational Study (JORTC PAL12)

Abstract

Background: Neuroleptics are commonly used in palliative care settings. However, adverse events of neuroleptics, known as extrapyramidal symptoms (EPSs), might be overlooked in clinical practice. We conducted this study to explore the prevalence of EPSs in palliative care setting. Methods: This multicenter, prospective, observational study included patients who 1) were referred to either a specialist palliative care team or a palliative care unit, 2) had a diagnosis of cancer, and 3) were ≥20 years of age. We investigated the prevalence of EPSs and medications used. The primary outcome was the overall Drug-Induced Extrapyramidal Symptom Scale (DIEPSS) score. Results: Between November 2015 and October 2016, 149 patients from 5 centers in Japan were enrolled. The median age was 67 years (range: 21–88 years) and the study population included 81 men (54.4%). The cancer types included lung (55 patients, 36.9%), upper gastrointestinal tract (5, 3.3%), hepatobiliary (19, 12.8%); breast (12, 8.1%); head and neck (10, 6.7%), gynecologic (10, 6.7%), genitourinary (10, 6.7%), and others (28, 18.8%). The median Karnofsky performance status was 60 (20–100). Most patients (86.6%) did not experience delirium. Thirty-nine (26.2%) patients received one or more EPS-inducing medications. EPSs occurred in 4 (2.7%) patients with a cutoff score of 5 points for 5 parkinsonism items in DIEPSS. Conclusion: A lower frequency (<3%) of patients than expected in this population had EPSs. Therefore, we concluded that an interventional study is not feasible. However, medications that cause EPSs are often used in palliative care; therefore, a longitudinal study is warranted. Trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) (UMIN000019810) on 16, November, 2015.

Neurology Case Report: Rapidly Progressive Dementia and Extrapyramidal Symptoms as the First Presentation of Leptomeningeal Carcinomatosis

“…EPS includes disturbances in movement, tone, and/or posture, dystonia, parkinsonian signs, tardive dyskinesia, and tardive akathisia [ 16 , 17 ]. EPS occurs due to disturbances in the dopaminergic neurons in the central nervous system [ 18 ]. It also commonly occurs with medication use, especially with the use of antipsychotic medications such as haloperidol, risperidone, olanzapine, chlorpromazine, and prochlorperazine.…”

“…EPS has been reported in up to 60% of patients taking long-term antipsychotics [ 19 ]. Ishiki et al investigated the prevalence of EPS in cancer patients undergoing palliative therapy [ 18 ]. They found that 14.8% of patients with EPS had metastasis to the brain, although some of them may have taken medications that caused the EPS [ 18 ].…”

“…Ishiki et al investigated the prevalence of EPS in cancer patients undergoing palliative therapy [ 18 ]. They found that 14.8% of patients with EPS had metastasis to the brain, although some of them may have taken medications that caused the EPS [ 18 ]. The occurrence of EPS with LC has previously been reported; in the case reported by Francolini et al, his patient suffered from rapid cognitive decline, gait disturbances, postural instability, and dysarthria [ 20 ].…”