Delirium in advanced cancer patients

Centeno, Carlos; Sanz, Álvaro; Bruera, Éduardo

doi:10.1191/0269216304pm879oa

Cited by 180 publications

(131 citation statements)

References 58 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…On the contrary, shorter delirium was associated with functional recovery. In this respect, these results confirmed previous findings which have shown that delirium has an acute impact on the level of functioning 13 , however, add new insights into the necessity of active management with antipsychotics in order to reverse this effect. Furthermore, brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment.…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Delirium and functionality: the impact of delirium on the level of functioning

Boettger¹,

Breitbart

Jenewein³

et al. 2014

Eur. J. Psychiat.

View full text Add to dashboard Cite

-Background and Objectives: Studies have shown showed that delirium affects the long-term functional status, however, the acute effect of delirium on functioning has been less documented. The purpose of this analysis was to examine the acute impact of delirium on the level of functioning.Methods: All patients were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). The Memorial Delirium Assessment Scale (MDAS) and Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3). A secondary analysis in respect to sociodemographic and medical variables, aspects of delirium, and level of functioning was performed.Results: Delirium severity at baseline did not affect the level of functioning, however, resolved delirium resulted in substantial functional recovery compared to persistent delirium at T2 (30.2 and 23.5) and T3 (35.1 and 26.2). Patients with persistent functional impairment were not different in age, pre-existing dementia or brain metastasis compared to those with functional recovery. However, brain cancer, terminal illness, hypoxia and multiple etiologies caused persistent functional decline. Although delirium severity was not different at baseline, delirium was more severe in the functionally-impaired at T2 and T3. Similarly, delirium resolution was inferior in these patients in contrast to the functionally-recovered at T2 (25% and 65.4%) and T3 (62.5% and 83.3%). On the contrary, the duration of delirium affected functional recovery; shorter delirium predicted faster functional recovery.Conclusions: Delirium caused an acute functional decline and appropriate management of delirium with antipsychotics reversed this decline. On the contrary, shorter duration of delirium was associated with faster functional recovery. Brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment.

show abstract

Section: Discussionsupporting

confidence: 81%

“…In addition, delirium has been shown to lead to an acute decline in functional status 12 , to be one of the most common reasons for admission to the hospital in patients with advanced cancer and to herald an even greater decline in performance 13 . In fact, the effect on the functional status is prominent.…”

Section: Introductionmentioning

confidence: 99%

Delirium and functionality: the impact of delirium on the level of functioning

Boettger¹,

Breitbart

Jenewein³

et al. 2014

Eur. J. Psychiat.

View full text Add to dashboard Cite

show abstract

“…Only 22 patients (25%) were able to complete both the baseline and follow-up ESAS. For the patients who did complete the ESAS, significant improvements were documented in pain ( Delirium improved in 21 patients (30%) who were able to complete the MDAS from an initial median score of 13 (range, 8-21) to a median MDAS score of 11 (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of these 21 patients, 20 (95%) were discharged alive (9 patients were discharged to home with hospice services, 5 patients were discharged to an inpatient hospice unit, 4 patients were discharged to home with outpatient follow-up, and 2 patients were discharged to a skilled nursing facility).…”

Section: (26)mentioning

confidence: 99%

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

Delgado-Guay

Parsons

et al. 2009

Cancer

Self Cite

110

View full text Add to dashboard Cite

BACKGROUND:The symptom burden of intensive care unit (ICU) patients who are referred to a palliative care team (PCT) has not been characterized to the authors' knowledge, and the response of these symptoms to the palliative care intervention has not been reported.METHODS:The authors retrospectively reviewed PCT consults for ICU patients who were seen between July 2006 and October 2007. To characterize symptom distress and outcomes in ICU patients who were referred to PCT in a cancer center, information and descriptive statistics about patients' demographics, comorbidities, PCT findings, interventions, and outcomes were obtained. The chi‐square test was used to analyze ICU and PCT mortality, and the signed‐rank test was used to analyze PCT interventions.RESULTS:Of 1637 PCT consults, 88 consults (5%) were from the ICU. The median patient age was 60 years (range, 22‐87 years), and 41 patients (46%) were women. The types of cancers were hematologic (19 patients; 22%), gastrointestinal (19 patients; 22%), lung (18 patients; 20%), and others (24 patients; 26%). Nineteen patients were on mechanical ventilation (MV), and 24 patients were on bilevel positive airway pressure (BIPAP). The findings were delirium (71 patients; 81%), dyspnea (67 patients; 76%), pain (74patients; 84%), fatigue (84 patients; 95%), and anxiety (57 patients; 65%). The interventions used were opioid management (99%), steroids (70%), antipsychotics (76%), and counseling (100%), do not resuscitate conversion (62 of 88 patients; 70%), withdrawal of MV (15 of 19 patients; 79%), and withdrawal of BIPAP (26 of 26 patients; 100%). Improvement was reported in pain (67 patients; 90%), dyspnea (60 patients; 90%), anxiety (51 patients; 80%), and delirium (31 patients; 44%). Thirty‐five patients (40%) were transferred to the palliative care unit (PCU). Fifty‐one ICU/PCT patients (58%) died during admission versus 130 of 1549 (8%) non‐ICU PCT patients (P < .0001). Twenty‐three of 35 patients who were transferred to the PCU (66%) died there versus 212 of 629 patients (34%) who were admitted to the PCU from another service (P < .0001). Thirty‐seven of 88 ICU/PCT patients (42%) were discharged alive.CONCLUSIONS:ICU patients who are referred to the PCT have severe symptom distress. The PCT was able to identify multiple problems and make numerous pharmacologic and nonpharmacologic recommendations that improved these symptoms, including the participation in do not resuscitate conversion and withdrawal of MV and BIPAP. Although many patients in this population died, a significant subset, including those who were transferred to the PCU, survived to discharge. Cancer 2009. © 2009 American Cancer Society.

show abstract

“…66 As patients with cancer or other diagnoses approach the end of their lives, more than 80% may experience delirium. 27,29,[66][67][68][69][70] One-third of palliative care patients experience terminal delirium while they are actively dying. 71 Delirium can be a frightening and distressing experience for patients, families, and caregivers.…”

Section: -65mentioning

confidence: 99%

The Opportunity for Psychiatry in Palliative Care

Irwin

Ferris

2008

Can J Psychiatry

View full text Add to dashboard Cite

The need for psychiatrists to work with patients and families living with chronic life-threatening illnesses has never been greater. Further, psychiatrists may find exciting work within the relatively new field of palliative care, which is devoted to the prevention and relief of all suffering. Increasingly, individuals are living longer with multiple issues that cause suffering, interfere with their lives, and often lead to psychosocial sequelae. To ensure state-of-the-art care for patients and families throughout an illness and any ensuing bereavement period, many experienced psychiatrists are needed as consultants to, and as members of, interdisciplinary palliative care teams. This need presents limitless opportunities for psychiatrists to care for patients, provide education, and engage in research. The potential to make a difference is great.

show abstract

Delirium in advanced cancer patients

Cited by 180 publications

References 58 publications

Delirium and functionality: the impact of delirium on the level of functioning

Delirium and functionality: the impact of delirium on the level of functioning

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

The Opportunity for Psychiatry in Palliative Care

Contact Info

Product

Resources

About