The Impact of Delirium on the Circadian Distribution of Breakthrough Analgesia in Advanced Cancer Patients

Gagnon, Bruno; Lawlor, Peter; Mancini, Isabelle; Pereira, João Pablo Fortes; Hanson, John; Bruera, Éduardo

doi:10.1016/s0885-3924(01)00339-6

Cited by 44 publications

(27 citation statements)

References 18 publications

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“…[1][2][3][4] The presence of delirium can interfere with the recognition and control of physical and psychological symptoms such as pain. 5,6 Delirium is often under-recognized or misdiagnosedinpatientswithcancer;evenwhenrecognized, it frequently goes untreated or is inappropriately treated. Clinicians who care for patients with cancer must be able to diagnose delirium accurately, undertake appropriate assessment of etiologies, and understand the risks and benefits of the pharmacologic and nonpharmacologic interventions currently available for managing delirium.…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Treatment of Delirium in Patients With Cancer

Breitbart

Alici

2012

JCO

153

114

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Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium.

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Section: Introductionmentioning

confidence: 99%

Evidence-Based Treatment of Delirium in Patients With Cancer

Breitbart

Alici

2012

JCO

153

114

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“…1 Delirium in patients with cancer has been associated with adverse outcomes, including decreased performance status 2 ; increased pain and use of breakthrough analgesia 3,4 ; longer length of hospital stay 5,6 ; increased distress for the patient, spouse, caregivers, and nurses [7][8][9] ; and decreased survival.…”

Section: Introductionmentioning

confidence: 99%

Pre- and Post-Transplantation Risk Factors for Delirium Onset and Severity in Patients Undergoing Hematopoietic Stem-Cell Transplantation

Fann

Hubbard

Alfano

et al. 2011

JCO

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A B S T R A C T PurposeTo determine pre-and post-transplantation risk factors for delirium onset and severity during the acute phase of myeloablative hematopoietic stem-cell transplantation (HSCT). Patients and MethodsNinety adult patients with malignancies admitted to the Fred Hutchinson Cancer Research Center for their first HSCT were assessed prospectively from 1 week before transplantation to 30 days after transplantation. Delirium was assessed three times per week using the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Potential risk factors were assessed by patient self-report, charts, and computerized records. Multivariable analysis of time to onset of a delirium episode was undertaken using Cox proportional hazards regression with time-varying covariates. Analysis for delirium severity was carried out using a linear mixed effects model. Validation and sensitivity analyses were performed on the final models. ResultsForty-five patients (50%) experienced a delirium episode. Pretransplantation risk factors for onset and higher severity of delirium were higher mean alkaline phosphatase and blood urea nitrogen (BUN) levels. Poorer pretransplantation executive functioning was also associated with higher delirium severity. Higher doses of opioid medications were the only posttransplantation risk factor for delirium onset (hazard ratio, 1.05; 95% CI, 1.02 to 1.08). Higher opioid doses, current and prior pain, and higher BUN levels were post-transplantation risk factors for greater delirium severity (all P Ͻ .01). ConclusionPre-and post-transplantation factors can assist in identifying patients who are at risk for delirium during myeloablative HSCT and may enable clinical interventions to prevent delirium onset or decrease delirium symptoms. J Clin

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“…Because circadian rhythms may influence pain expression, delirium can alter the normal circadian rhythm and may modify the pain expression. It was found that patients without delirium tended to use more breakthrough medication in the morning and those with delirium used more medication in the evening and at night, which was consistent with their reversal of normal circadian cycling [47]. When observing patients who have an increased need for breakthrough medication in the evening more so than in the morning, practitioners should remember that this may herald the development of overt delirium.…”

Section: Delirium and Dementia At The End Of Lifementioning

confidence: 73%

The psychiatric management of end-of-life pain and associated psychiatric comorbidity

Cole

2003

Current Science Inc

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Involvement by psychiatrists in the care of patients who are terminally ill has been limited historically; however, psychiatrists increasingly are participating in the care of these people who are facing the most challenging times of their lives. Pain management is considered to be an area of subspecialization for psychiatrists beyond their traditional role of being psychopharmacologists and psychotherapists. Biologically focused psychiatrists are able to address neuropsychiatric disorders, including pain and depression in the medically ill, and actively improve the quality of life for dying patients and their family members. This article provides a review of the recent literature that has addressed the involvement of psychiatrists in end-of-life care. Beginning with an example of the scientific aspects of cancer-related treatment from a patient's perspective, and into the major treatment considerations, this article addresses pain, its recognition, and management challenges when the end of life approaches. The prompt recognition of frequently overlooked and underestimated concomitant depressions, delirium, dementia, and other mental disorders is important for mental health specialists. The importance of psychiatric care for patients who are terminally ill and the role of psychiatrists in the phase of care also are discussed.

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The Impact of Delirium on the Circadian Distribution of Breakthrough Analgesia in Advanced Cancer Patients

Cited by 44 publications

References 18 publications

Evidence-Based Treatment of Delirium in Patients With Cancer

Evidence-Based Treatment of Delirium in Patients With Cancer

Pre- and Post-Transplantation Risk Factors for Delirium Onset and Severity in Patients Undergoing Hematopoietic Stem-Cell Transplantation

The psychiatric management of end-of-life pain and associated psychiatric comorbidity

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