Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R)

on behalf of Phase-R Delirium Study Group

Research output: Contribution to journalArticle

Abstract

Background: Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. Subjects, Materials, and Methods: We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2). Results: Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy. Conclusion: Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. Implications for Practice: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.

Original languageEnglish
JournalOncologist
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Delirium
Pharmacology
Safety
Drug Therapy
Neoplasms
Palliative Care
Pharmacovigilance
Haloperidol

Keywords

  • Antipsychotic agents
  • Delirium
  • Neoplasms
  • Palliative care
  • Pharmacovigilance

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{b1dc9414036a4d6d8edcf7e300b10024,
title = "Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R)",
abstract = "Background: Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. Subjects, Materials, and Methods: We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2). Results: Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37{\%}). A total of 67 and 42 patients (31{\%} and 19{\%}) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9{\%}). Delirium severity worsened after starting pharmacotherapy in 121 patients (56{\%}) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy. Conclusion: Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. Implications for Practice: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.",
keywords = "Antipsychotic agents, Delirium, Neoplasms, Palliative care, Pharmacovigilance",
author = "{on behalf of Phase-R Delirium Study Group} and Toru Okuyama and Kazuhiro Yoshiuchi and Asao Ogawa and Satoru Iwase and Naosuke Yokomichi and Akihiro Sakashita and Keita Tagami and Keiichi Uemura and Rika Nakahara and Tatsuo Akechi and Hirofumi Abo and Nobuya Akizuki and Koji Amano and Daisuke Fujisawa and Shingo Hagiwara and Takeshi Hirohashi and Takayuki Hisanaga and Kengo Imai and Shuji Inada and Satoshi Inoue and Shinichiro Inoue and Aio Iwata and Keisuke Kaneishi and Akifumi Kumano and Isseki Maeda and Yoshinobu Matsuda and Takashi Matsui and Yoshihisa Matsumoto and Naoki Matsuo and Kaya Miyajima and Ichiro Mori and Sachiyo Morita and Nobuhisa Nakajima and Hiroyuki Nobata and Takuya Odagiri and Ken Shimizu and {Sumazaki Watanabe}, Yuki and Emi Takeuchi and Mari Takeuchi and Ryohei Tatara and Akihiro Tokoro and Megumi Uchida and Hiroaki Watanabe and Ritsuko Yabuki and {Toshihiro Yamauchi}, and",
year = "2019",
month = "1",
day = "1",
doi = "10.1634/theoncologist.2018-0242",
language = "English",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",

}

TY - JOUR

T1 - Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer

T2 - Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R)

AU - on behalf of Phase-R Delirium Study Group

AU - Okuyama, Toru

AU - Yoshiuchi, Kazuhiro

AU - Ogawa, Asao

AU - Iwase, Satoru

AU - Yokomichi, Naosuke

AU - Sakashita, Akihiro

AU - Tagami, Keita

AU - Uemura, Keiichi

AU - Nakahara, Rika

AU - Akechi, Tatsuo

AU - Abo, Hirofumi

AU - Akizuki, Nobuya

AU - Amano, Koji

AU - Fujisawa, Daisuke

AU - Hagiwara, Shingo

AU - Hirohashi, Takeshi

AU - Hisanaga, Takayuki

AU - Imai, Kengo

AU - Inada, Shuji

AU - Inoue, Satoshi

AU - Inoue, Shinichiro

AU - Iwata, Aio

AU - Kaneishi, Keisuke

AU - Kumano, Akifumi

AU - Maeda, Isseki

AU - Matsuda, Yoshinobu

AU - Matsui, Takashi

AU - Matsumoto, Yoshihisa

AU - Matsuo, Naoki

AU - Miyajima, Kaya

AU - Mori, Ichiro

AU - Morita, Sachiyo

AU - Nakajima, Nobuhisa

AU - Nobata, Hiroyuki

AU - Odagiri, Takuya

AU - Shimizu, Ken

AU - Sumazaki Watanabe, Yuki

AU - Takeuchi, Emi

AU - Takeuchi, Mari

AU - Tatara, Ryohei

AU - Tokoro, Akihiro

AU - Uchida, Megumi

AU - Watanabe, Hiroaki

AU - Yabuki, Ritsuko

AU - Toshihiro Yamauchi, and

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. Subjects, Materials, and Methods: We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2). Results: Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy. Conclusion: Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. Implications for Practice: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.

AB - Background: Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. Subjects, Materials, and Methods: We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2). Results: Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy. Conclusion: Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. Implications for Practice: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.

KW - Antipsychotic agents

KW - Delirium

KW - Neoplasms

KW - Palliative care

KW - Pharmacovigilance

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U2 - 10.1634/theoncologist.2018-0242

DO - 10.1634/theoncologist.2018-0242

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JO - Oncologist

JF - Oncologist

SN - 1083-7159

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