Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R)

The oncologist

article

Toru Okuyama¹  Tatsuo Akechi¹  Kazuhiro Yoshiuchi³  Asao Ogawa⁴  Satoru Iwase⁵  Naosuke Yokomichi⁶  Akihiro Sakashita⁷  Keita Tagami⁸  Keiichi Uemura⁹  Rika Nakahara^1,10 

[1] Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital;Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences;Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo;Department of Psycho-Oncology Service, National Cancer Center Hospital East;Department of Palliative Medicine, Saitama Medical University;Seirei Mikatahara General Hospital;Department of Palliative Medicine, Kobe University Graduate School of Medicine;Department of Palliative Medicine, Tohoku University School of Medicine;Department of Psychiatry, Hokkaido Medical Center;Department of Psycho-Oncology, National Cancer Center Hospital

关键词: Delirium;    Neoplasms;    Antipsychotic agents;    Palliative care;    Pharmacovigilance;   

DOI  :  10.1634/theoncologist.2018-0242

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. Subjects, Materials, and Methods We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2). Results Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy. Conclusion Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. Implications for Practice Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.

【 授权许可】

CC BY|CC BY-NC