Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study.

Abstract

CONTEXT:

Delirium impedes communication and contributes to symptom distress in patients with advanced cancer. There are few prospective data on the reversal of delirium in this population.

OBJECTIVES:

To evaluate the occurrence, precipitating factors, and reversibility of delirium in patients with advanced cancer.

DESIGN:

Prospective serial assessment in a consecutive cohort of 113 patients with advanced cancer. Precipitating factors were examined using standardized criteria; 104 patients met eligibility criteria.

SETTING:

Acute palliative care unit in a university-affiliated teaching hospital.

MAIN OUTCOME MEASURES:

Delirium occurrence and reversal rates, duration, and patient survival. Strengths of association of various precipitating factors with reversal were expressed as hazard ratios (HRs) in univariate and multivariate analyses.

RESULTS:

On admission, delirium was diagnosed in 44 patients (42%), and of the remaining 60, delirium developed in 27 (45%). Reversal of delirium occurred in 46 (49%) of 94 episodes in 71 patients. Terminal delirium occurred in 46 (88%) of the 52 deaths. In univariate analysis, psychoactive medications, predominantly opioids (HR, 8.85; 95% confidence interval [CI], 2.13-36.74), and dehydration (HR, 2.35; 95% CI, 1.20-4.62) were associated with reversibility. Hypoxic encephalopathy (HR, 0.39; 95% CI, 0.19-0.80) and metabolic factors (HR, 0.44; 95% CI, 0.21-0.91) were associated with nonreversibility. In mulitivariate analysis, psychoactive medications (HR, 6.65; 95% CI, 1.49-29.62), hypoxic encephalopathy (HR, 0.32; 95% CI, 0.15-0.70), and nonrespiratory infection (HR, 0.23; 95% CI, 0.08-0.64) had independent associations. Patients with delirium had poorer survival rates than controls (P<.001).

CONCLUSIONS:

Delirium is a frequent, multifactorial complication in advanced cancer. Despite its terminal presentation in most patients, delirium is reversible in approximately 50% of episodes. Delirium precipitated by opioids and other psychoactive medications and dehydration is frequently reversible with change of opioid or dose reduction, discontinuation of unnecessary psychoactive medication, or hydration, respectively.

• Authors: P G Lawlor, B Gagnon, I L Mancini, J L Pereira, J Hanson, M E Suarez-Almazor, E D Bruera
• Journal: Archives of internal medicine (Arch Intern Med) Vol. 160 Issue 6 Pg. 786-94 (Mar 27 2000) ISSN: 0003-9926 [Print] United States
• PMID: 10737278 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid

Topics

• Aged
• Alcohol Drinking
• Analgesics, Opioid (administration & dosage)
• Dehydration (therapy)
• Delirium (etiology, metabolism, therapy)
• Female
• Fluid Therapy
• Hospitals, University
• Humans
• Hypoxia (therapy)
• Incidence
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasms (complications, metabolism)
• Precipitating Factors
• Prospective Studies
• Risk Factors
• Survival Analysis
• Treatment Outcome