Naoki Matsuo1, Tatsuya Morita2, Yoshinobu Matsuda3, Kenichiro Okamoto4, Yoshihisa Matsumoto5, Keisuke Kaneishi6, Takuya Odagiri7, Hiroki Sakurai8, Hideki Katayama9, Ichiro Mori10, Hirohide Yamada11, Hiroaki Watanabe7, Taro Yokoyama12, Takashi Yamaguchi13, Tomohiro Nishi14, Akemi Shirado15, Shuji Hiramoto16, Toshio Watanabe17, Hiroyuki Kohara18, Satofumi Shimoyama19, Etsuko Aruga20, Mika Baba21, Koki Sumita22, Satoru Iwase23. 1. 1 Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital , Akita, Japan . 2. 2 Palliative and Supportive care Division, Seirei Mikatahara General Hospital , Hamamatsu, Japan . 3. 3 Department of Psychosomatic Internal Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center , Sakai, Japan . 4. 4 Palliative Medicine, Showa University Northern Yokohama Hospital , Yokohama, Japan . 5. 5 Department of Palliative Medicine, National Cancer Center Hospital East , Kashiwa, Japan . 6. 6 Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center , Tokyo, Japan . 7. 7 Komaki City Hospital , Komaki, Japan . 8. 8 Department of Palliative Care and Pain Management, Cancer Institute Hospital , Tokyo, Japan . 9. 9 NHO Yamaguchi-Ube Medical Center , Ube, Japan . 10. 10 Gratia hospital hospice , Mino, Japan . 11. 11 Seirei Hamamatsu General Hospital , Hamamatsu, Japan . 12. 12 Department of Palliative Medicine, Yokohama Municipal Citizens Hospital , Yokohama, Japan . 13. 13 Department of Palliative Medicine, Kobe University Graduate School of Medicine , Kobe, Japan . 14. 14 Kawasaki Municipal Ida Hospital , Kawasaki, Japan . 15. 15 Seirei Mikatahara General Hospital , Hamamatsu, Japan . 16. 16 Department of Oncology, Mitsubishi Kyoto Hospital , Kyoto, Japan . 17. 17 Toyama Prefectural Central Hospital , Toyama, Japan . 18. 18 Department of Palliative Care, Hiroshima Prefectural Hospital , Hiroshima, Japan . 19. 19 Department of Palliative Care, Aichi Cancer Center Hospital , Nagoya, Japan . 20. 20 Department of Palliative medicine, Teikyo University School of Medicine , Tokyo, Japan . 21. 21 Palliative care Division, Saito Yukoukai Hospital , Osaka, Japan . 22. 22 Matsue City Hospital , Matsue, Japan . 23. 23 Research Hospital, The Institute of Medical Science, The University of Tokyo , Tokyo, Japan .
Abstract
BACKGROUND: Corticosteroids are often used to treat fatigue and anorexia, but occasionally produce delirium. Information on the predictors of delirium in corticosteroid-treated cancer patients remains limited. OBJECTIVE: To identify potential factors predicting the development of delirium in corticosteroid-treated cancer patients. DESIGN: An exploratory, multicenter, prospective, observational study. SETTING/ SUBJECTS: Inclusion criteria for this study were patients who had metastatic or locally advanced cancer and a fatigue or anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale. MEASUREMENT: Univariate and multivariable analyses were performed to identify the predictors of delirium diagnosed by the Confusion Assessment Method (CAM) within three days of initiation of corticosteroids. RESULTS: Among 207 patients administered corticosteroids, 35 (17%; 95% confidence interval [CI] 12%-23%) developed at least one episode of delirium diagnosed by the CAM. Factors predictive of the development of delirium were as follows: Palliative Performance Scale ≤20, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 4, the Support Team Assessment Schedule (STAS) score of drowsiness >1, concurrent opioid use, parenteral hydration volume ≤500 mL, and the absence of lung metastasis. A multivariable analysis identified the independent factors predicting responses as ECOG PS = 4 (odds ratio [OR] 4.0; 95% CI 1.7-9.3), STAS score of drowsiness >1 (OR 3.4; 95% CI 1.4-8.2), and concurrent opioid use (OR 3.7; 95% CI 1.0-13). CONCLUSION: Delirium in corticosteroid-treated advanced cancer patients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.
BACKGROUND: Corticosteroids are often used to treat fatigue and anorexia, but occasionally produce delirium. Information on the predictors of delirium in corticosteroid-treated cancerpatients remains limited. OBJECTIVE: To identify potential factors predicting the development of delirium in corticosteroid-treated cancerpatients. DESIGN: An exploratory, multicenter, prospective, observational study. SETTING/ SUBJECTS: Inclusion criteria for this study were patients who had metastatic or locally advanced cancer and a fatigue or anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale. MEASUREMENT: Univariate and multivariable analyses were performed to identify the predictors of delirium diagnosed by the Confusion Assessment Method (CAM) within three days of initiation of corticosteroids. RESULTS: Among 207 patients administered corticosteroids, 35 (17%; 95% confidence interval [CI] 12%-23%) developed at least one episode of delirium diagnosed by the CAM. Factors predictive of the development of delirium were as follows: Palliative Performance Scale ≤20, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 4, the Support Team Assessment Schedule (STAS) score of drowsiness >1, concurrent opioid use, parenteral hydration volume ≤500 mL, and the absence of lung metastasis. A multivariable analysis identified the independent factors predicting responses as ECOG PS = 4 (odds ratio [OR] 4.0; 95% CI 1.7-9.3), STAS score of drowsiness >1 (OR 3.4; 95% CI 1.4-8.2), and concurrent opioid use (OR 3.7; 95% CI 1.0-13). CONCLUSION:Delirium in corticosteroid-treated advanced cancerpatients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.
Authors: Arjun Kingdon; Anna Spathis; Robert Brodrick; Gemma Clarke; Isla Kuhn; Stephen Barclay Journal: BMJ Support Palliat Care Date: 2020-10-12 Impact factor: 3.568