Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study

Naoki Matsuo, Tatsuya Morita, Yoshinobu Matsuda, Kenichiro Okamoto, Yoshihisa Matsumoto, Keisuke Kaneishi, Takuya Odagiri, Hiroki Sakurai, Hideki Katayama, Ichiro Mori, Hirohide Yamada, Hiroaki Watanabe, Taro Yokoyama, Takashi Yamaguchi, Tomohiro Nishi, Akemi Shirado, Shuji Hiramoto, Toshio Watanabe, Hiroyuki Kohara, Satofumi ShimoyamaEtsuko Aruga, Mika Baba, Koki Sumita, Satoru Iwase

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: Corticosteroids are often used to treat fatigue and anorexia, but occasionally produce delirium. Information on the predictors of delirium in corticosteroid-treated cancer patients remains limited. Objective: To identify potential factors predicting the development of delirium in corticosteroid-treated cancer patients. Design: An exploratory, multicenter, prospective, observational study. Setting/Subjects: Inclusion criteria for this study were patients who had metastatic or locally advanced cancer and a fatigue or anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale. Measurement: Univariate and multivariable analyses were performed to identify the predictors of delirium diagnosed by the Confusion Assessment Method (CAM) within three days of initiation of corticosteroids. Results: Among 207 patients administered corticosteroids, 35 (17%; 95% confidence interval [CI] 12%-23%) developed at least one episode of delirium diagnosed by the CAM. Factors predictive of the development of delirium were as follows: Palliative Performance Scale ≤20, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 4, the Support Team Assessment Schedule (STAS) score of drowsiness >1, concurrent opioid use, parenteral hydration volume ≤500 mL, and the absence of lung metastasis. A multivariable analysis identified the independent factors predicting responses as ECOG PS = 4 (odds ratio [OR] 4.0; 95% CI 1.7-9.3), STAS score of drowsiness >1 (OR 3.4; 95% CI 1.4-8.2), and concurrent opioid use (OR 3.7; 95% CI 1.0-13). Conclusion: Delirium in corticosteroid-treated advanced cancer patients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.

Original languageEnglish
Pages (from-to)352-359
Number of pages8
JournalJournal of Palliative Medicine
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 1 2017
Externally publishedYes

Keywords

  • cancer
  • corticosteroids
  • palliative care
  • predictors

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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