Delirium incidence, risk factors, and treatments in older adults receiving chemotherapy: A systematic review and meta-analysis

Jung, Patrick; Puts, Martine; Frankel, Nelly; Syed, Ali; Alam, Zuhair; Yeung, Lily; Malik, Uzair; Rosario, Carla O.; Ayala, Ana Patricia; Hudson, John W.; Alibhai, Shabbir M.H.

doi:10.1016/j.jgo.2020.08.011

Cited by 13 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the risk of postoperative delirium and possibly delirium associated with chemotherapy use is higher in patients with cognitive impairment. 43,44 Patients who suffer from depression or anxiety also need special attention. Depression is a risk factor for mortality, postoperative complications, and poor adherence to treatment.…”

Section: Nononcologic Management Based On Gamentioning

confidence: 99%

Geriatric Assessment and Management in Cancer

Rostoft

O’Donovan

Soubeyran

et al. 2021

JCO

View full text Add to dashboard Cite

A second choice concerns which patients will receive GA. This can be based on age or clinical judgment, or alternatively, patients can be selected with a frailty screening instrument, where only those below a certain cutoff undergo GA. There are multiple short screening tools available, of which Geriatric-8 (G8) has been most extensively CONTEXT Key ObjectiveWhy is geriatric assessment and management (GA&M) recommended for older patients with cancer pretreatment? Knowledge Generated Older patients are heterogeneous, and tailoring cancer treatment to the individual requires weighing risks against benefits in the context of frailty, which is best assessed through geriatric assessment. GA&M can improve prognostication and risk stratification and communication with patients and caregivers, guide treatment adaptations, and provide nononcologic interventions to increase resilience. Relevance As increasing evidence shows that GA&M can improve the course of treatment, with less chemotherapy-related toxicity, lower rates of complications after surgery, and improved functional status and quality of life, the challenge is now about implementation into clinical practice. TABLE 1. Geriatric Assessment Domains, Tools, and Proposed Interventions Domain Assessment Tool Examples Evidence Intervention and Examples Functional status ADLs (ie, transferring and eating) IADLs (ie, managing finances, cooking, and driving) Association with chemotherapy toxicity, hospital admissions, functional decline, and mortality 4,39,46,55 Aids such as motorized wheelchair Meals on Wheels Physiotherapy Occupational therapy Objective physical performance 4 m gait speed, TUG; SPPB; grip strength; sarcopenia Prediction of mortality, treatment-related complications, and functional decline 56-58 Structured exercise Assistive devices Falls No. falls in previous 6 months Related to chemotherapy toxicity, postoperative complications, and functional decline 24,59 Falls prevention program Cognitive function MMSE, MoCA, Mini-Cog, and BOMC Assessment of capacity for consent or treatment adherence and cognitive decline associated with treatment. Association with poorer overall survival, chemotherapy toxicity, and delirium 22,43,60 Support during treatment trajectory Delirium prevention program Treatment reminders, eg, text messages for daily radiation therapy appointments Mood (depression) GDS, HADS, and PHQ2/9 Assessment of psychologic adjustment to treatment. Association with postoperative complications, treatment tolerance, functional decline, and mortality 45,46,55,61 Cognitive-behavioral therapy Medical therapy Counseling Nutritional status MNA, BMI, and weight loss combined Association with mortality, likelihood of treatment completion, and healthcare consumption 62,63 Dietary counseling Comorbidity CIRS-G, CCI, and OARS comorbidity Assessment of competing causes of mortality, survival, treatment tolerance, and hospital admissions 61,64 Referral to organ specialist Polypharmacy List of medications, STOPP-START, and Beers criteria Postoperative complication...

show abstract

Section: Nononcologic Management Based On Gamentioning

confidence: 99%

Geriatric Assessment and Management in Cancer

Rostoft

O’Donovan

Soubeyran

et al. 2021

JCO

View full text Add to dashboard Cite

show abstract

“…Similarly, while delirium is a separate entity of acute cognitive decline, it is important to be aware that those with baseline cognitive impairment are at a far higher risk of developing a delirium episode during their cancer treatment phase [1,8]. Education regarding delirium monitoring for these patients and their caregivers is required [10,115,116].…”

Section: Discussionmentioning

confidence: 99%

“…Dementia is a more substantial cognitive decline in one or more cognitive domains in history and formal testing, with an associated reduction in functional independence (in the absence of other mental disorders) [9]. Delirium is an acute confusional state characterized by deficits in attention and concentration, which tends to fluctuate during the course of the day and is associated with physiological stressors [10]. A pre-existing cognitive impairment increases the risk of delirium with physiological stressors such as chemotherapy and surgery [1,8].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

et al. 2021

View full text Add to dashboard Cite

Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person’s cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.

show abstract

“…However, the ESMO guidance did not use meta-analysis to identify key risk factors ( 24 ). A recent systematic review limited to older cancer adults receiving chemotherapy revealed six independent risk factors for delirium, but all the risk factors were not included in pooled analyses ( 25 ).Our study was the first systematic review focusing on palliative care population and use meta-analysis to evaluate risk factors for delirium, which filled a research gap on delirium.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Objective: Delirium is common and highly distressing for the palliative care population. Until now, no study has systematically reviewed the risk factors of delirium in the palliative care population. Therefore, we performed a systematic review and meta-analysis to evaluate delirium risk factors among individuals receiving palliative care.Methods: We systematically searched PubMed, Medline, Embase, and Cochrane database to identify relevant observational studies from database inception to June 2021. The methodological quality of the eligible studies was assessed by the Newcastle Ottawa Scale. We estimated the pooled adjusted odds ratio (aOR) for individual risk factors using the inverse variance method.Results: Nine studies were included in the review (five prospective cohort studies, three retrospective case-control studies and one retrospective cross-section study). In pooled analyses, older age (aOR: 1.02, 95% CI: 1.01–1.04, I2 = 37%), male sex (aOR:1.80, 95% CI: 1.37–2.36, I2 = 7%), hypoxia (aOR: 0.87, 95% CI: 0.77–0.99, I2 = 0%), dehydration (aOR: 3.22, 95%CI: 1.75–5.94, I2 = 18%), cachexia (aOR:3.40, 95% CI: 1.69–6.85, I2 = 0%), opioid use (aOR: 2.49, 95%CI: 1.39–4.44, I2 = 0%), anticholinergic burden (aOR: 1.18, 95% CI: 1.07–1.30, I2 = 9%) and Eastern Cooperative Oncology Group Performance Status (aOR: 2.54, 95% CI: 1.56–4.14, I2 = 21%) were statistically significantly associated with delirium.Conclusion: The risk factors identified in our review can help to highlight the palliative care population at high risk of delirium. Appropriate strategies should be implemented to prevent delirium and improve the quality of palliative care services.

show abstract

Delirium incidence, risk factors, and treatments in older adults receiving chemotherapy: A systematic review and meta-analysis

Cited by 13 publications

References 29 publications

Geriatric Assessment and Management in Cancer

Geriatric Assessment and Management in Cancer

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About