Annina Seiler1,2, David Blum2, Jeremy Werner Deuel3, Caroline Hertler2, Markus Schettle2, Carl Moritz Zipser1,4, Jutta Ernst5, Maria Schubert6, Roland von Känel1, Soenke Boettger7. 1. Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland. 2. Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland. 3. Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK. 4. Department of Neurology and Neurophysiology, Balgrist University Hospital and University of Zurich, Zurich, Switzerland. 5. Center of Clinical Nursing Science, University Hospital Zurich and University of Zurich, Zurich, Switzerland. 6. School of Health Professions, University of Applied Science, Zurich, Switzerland. 7. University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Abstract
OBJECTIVE: Delirium is a frequent complication in advanced cancer patients, among whom it is frequently underdiagnosed and inadequately treated. To date, evidence on risk factors and the prognostic impact of delirium on outcomes remains sparse in this patient population. METHOD: In this prospective observational cohort study at a single tertiary-care center, 1,350 cancer patients were enrolled. Simple and multiple logistic regression models were utilized to identify associations between predisposing and precipitating factors and delirium. Cox proportional-hazards models were used to estimate the effect of delirium on death rate. RESULTS: In our patient cohort, the prevalence of delirium was 34.3%. Delirium was associated inter alia with prolonged hospitalization, a doubling of care requirements, increased healthcare costs, increased need for institutionalization (OR 3.22), and increased mortality (OR 8.78). Predisposing factors for delirium were impaired activity (OR 10.82), frailty (OR 4.75); hearing (OR 2.23) and visual impairment (OR 1.89), chronic pneumonitis (OR 2.62), hypertension (OR 1.46), and renal insufficiency (OR 1.82). Precipitating factors were acute renal failure (OR 7.50), pressure sores (OR 3.78), pain (OR 2.86), and cystitis (OR 1.32). On multivariate Cox regression, delirium increased the mortality risk sixfold (HR 5.66). Age ≥ 65 years and comorbidities further doubled the mortality risk of delirious patients (HR 1.77; HR 2.05). SIGNIFICANCE OF RESULTS: Delirium is common in cancer patients and associated with increased morbidity and mortality. Systematically categorizing predisposing and precipitating factors might yield new strategies for preventing and managing delirium in cancer patients.
OBJECTIVE:Delirium is a frequent complication in advanced cancerpatients, among whom it is frequently underdiagnosed and inadequately treated. To date, evidence on risk factors and the prognostic impact of delirium on outcomes remains sparse in this patient population. METHOD: In this prospective observational cohort study at a single tertiary-care center, 1,350 cancerpatients were enrolled. Simple and multiple logistic regression models were utilized to identify associations between predisposing and precipitating factors and delirium. Cox proportional-hazards models were used to estimate the effect of delirium on death rate. RESULTS: In our patient cohort, the prevalence of delirium was 34.3%. Delirium was associated inter alia with prolonged hospitalization, a doubling of care requirements, increased healthcare costs, increased need for institutionalization (OR 3.22), and increased mortality (OR 8.78). Predisposing factors for delirium were impaired activity (OR 10.82), frailty (OR 4.75); hearing (OR 2.23) and visual impairment (OR 1.89), chronic pneumonitis (OR 2.62), hypertension (OR 1.46), and renal insufficiency (OR 1.82). Precipitating factors were acute renal failure (OR 7.50), pressure sores (OR 3.78), pain (OR 2.86), and cystitis (OR 1.32). On multivariate Cox regression, delirium increased the mortality risk sixfold (HR 5.66). Age ≥ 65 years and comorbidities further doubled the mortality risk of delirious patients (HR 1.77; HR 2.05). SIGNIFICANCE OF RESULTS:Delirium is common in cancerpatients and associated with increased morbidity and mortality. Systematically categorizing predisposing and precipitating factors might yield new strategies for preventing and managing delirium in cancerpatients.
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Keywords:
Cancer patients; Delirium; Morbidity; Mortality; Precipitating factors; Predisposing factors