Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial

Hui, David; Rosa, Allison De La; Wilson, Annie; Nguyen, Thi Thuy Trang; Wu, Jimin; Delgado-Guay, Marvin Omar; Azhar, Ahsan; Arthur, Joseph; Epner, Daniel E.; Haider, Ali; Cruz, Maxine de la; Heung, Yvonne; Tanco, Kimberson; Dalal, Shalini; Reddy, Akhila; Williams, Janet L.; Amin, Sapna; Armstrong, Terri S.; Breitbart, William; Bruera, Éduardo

doi:10.1016/s1470-2045(20)30307-7

Cited by 52 publications

(43 citation statements)

References 28 publications

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“…of benzodiazepines (midazolam, lorazepam), antipsychotics (levomepromazine, chlorpromazine) or barbiturates (phenobarbitone) and less commonly anaesthetic agents (propofol). 33 , 75 Other medications for symptom management (e.g. opioid analgesia) are usually continued during sedation, especially if they have been effective.…”

Section: Symptom Managementmentioning

confidence: 99%

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

et al. 2021

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Highlights This ESMO Clinical Practice Guideline provides key recommendations for end-of-life care for patients with advanced cancer. It details care that is focused on comfort, quality of life and approaching death of patients with advanced cancer. All recommendations were compiled by a multidisciplinary group of experts. Recommendations are based on available scientific data and the authors’ collective expert opinion.

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Section: Symptom Managementmentioning

confidence: 99%

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…The second is the use of a unidimensional measure such as the RASS, with one direction toward agitation and another toward sedation. This method has been used in recent studies, 39 and they make interpretation easier. However, in such scales, the middle range (eg, 0 in the RASS) is the most desirable, and both directions demonstrate Empirical studies are urgently needed.…”

Section: Discussionmentioning

confidence: 99%

Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients?

et al. 2020

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Objectives: The objectives of this study are to investigate how many advanced cancer patients became unconscious or non-communicative after pharmacological treatment for delirium, and to explore whether existing delirium assessment tools can successfully evaluate its severity at the end of life. Methods: This was a secondary analysis of a registry study that examined the efficacy and safety of antipsychotics for advanced cancer patients with delirium. A total of 818 patients were recruited from 39 specialized palliative care services in Japan. The severity of delirium was measured using the Richmond Agitation-Sedation Scale-Palliative care version, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Nursing Delirium Screening Scale (Nu-DESC) on Day 3. Data from 302 patients with motor anxiety with an Agitation Distress Scale score ≥2 on Day 0 were analyzed for this study. The patients were categorized into four treatment response groups: complete response (CR: no agitation and fully communicative), partial response (PR: no/mild agitation and partially communicative), unconscious/non-communicative (UC), and no change (NC). Results: On Day 3, 29 (10%; 95% confidence intervals [CI], 7-13) and 2 (1%; 95% CI, 0-2) patients became unconscious and non-communicative, respectively. Forty-four patients were categorized as CR, 97 as PR, 31 as UC, and 96 as NC. The scores of the DRS-R-98 and Nu-DESC in the UC group were rated higher than patients in the NC group were. Conclusions: A considerable number of cancer patients with delirium became unconscious or non-communicative. Existing delirium assessment tools may be inappropriate for measuring the severity of delirium in end-of-life.

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“…Os resultados deste estudo revelaram a importância de maximizar as estratégias não farmacológicas e de reverter, dentro do possível, os fatores precipitantes. Porém, noutro estudo recente, Hui et al, 56 estudaram a eficácia de três estratégias farmacológicas no delirium terminal (haloperidol, rotação de neuroléptico para clorpromazina ou uso de haloperidol e clorpromazina em conjunto). Utilizando a Richmond Agitation Sedation Scale (RASS) demonstrou que as três estratégias reduziam significativamente as pontuações embora sem diferenças significativas entre grupos, sugerindo que os antipsicóticos parecem ser eficazes nos quadros de agitação relacionados com o delirium terminal.…”

Section: E Intervenção Terapêuticaunclassified

Delirium em Doentes com Cancro em Contexto de Cuidados Paliativos

Delgado¹,

Borges²,

Pimentel³

et al. 2021

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O delirium é uma síndrome neuropsiquiátrica complexa e multifatorial, altamente prevalente em todos os contextos de cuidados paliativos, nomeadamente em doentes com cancro. Pretende‑se com este artigo, com base na literatura atual, rever critérios de diagnóstico de delirium e suas características clínicas; instrumentos utilizados para avaliação; etiologia e patofisiologia; prevenção e estratégias terapêuticas nesta população específica. Foi revista a literatura publicada na base de dados online PubMed/Medline, entre 1987 e 2020, que abordasse o tratamento do delirium em contexto paliativo, através das palavras‑chave: delirium, cancer e palliative care. Embora a disfunção cerebral global associada ao delirium se manifeste por sintomas e sinais neurocognitivos ou neuropsiquiátricos, a característica fundamental desta síndrome é a perturbação da atenção. A etiologia do delirium é considerada multifatorial e o seu diagnóstico é pouco reconhecido pelos profissionais de saúde. Segundo a literatura, são necessárias várias estratégias de tratamento, tendo em conta os diversos fatores precipitantes, mecanismos patofisiológicos, subtipos e diferenças fenomenológicas encontrados no delirium. Apesar de largamente utilizados na prática clínica, não existe evidência suficiente para o uso habitual de antipsicóticos no tratamento do delirium em contexto paliativo. Do ponto de vista global, o objetivo deverá ser o tratamento de uma possível causa reversível e a otimização das estratégias não farmacológicas, sendo o uso de antipsicóticos reservado para os casos graves, de risco eminente, e refratários. Assim, a abordagem de tratamento do delirium em contexto de cuidados paliativos, deverá ter em conta os diversos subtipos de delirium, baseados nas diferentes etiologias, contextos e prognósticos, havendo necessidade de mais e melhores estudos, tanto do ponto de vista farmacológico como em estratégias combinadas, com clarificação de resultados que permitam aferir eficácia na resolução do quadro clínico e na qualidade de vida nesta população.

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Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial

Cited by 52 publications

References 28 publications

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients?

Delirium em Doentes com Cancro em Contexto de Cuidados Paliativos

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