Delirium Can Hinder Effectiveness of Palliative Care in Advanced Cancer
Patients with delirium had higher ESAS scores for a range of symptoms at each time point: depression, pain, sense of well-being, and global ESAS scores.
For patients with advanced cancer, delirium may influence the effectiveness of palliative care in symptom reduction, according to a study published in The Oncologist.
In this prospective analysis of 246 patients with advanced cancer, expression of symptoms was compared between baseline (T0) and after 7 days (T7) of treatment at a palliative care facility and with respect to presence of delirium at either time point. Delirium was defined as a score of 7/30 or higher on the Memorial Delirium Assessment Scale, and symptom expression was rated according to the Edmonton Symptom Assessment Scale (ESAS).
Delirium was present at T0 in 30.5% of patients and at T7 in 25.6% of patients, a decrease in frequency of 4.9%. This implies that cognitive status improved in 16% of patients who initially presented with the condition after palliative care was initiated. Ten patients developed delirium between T0 and T7.
Patients with delirium had higher ESAS scores for a range of symptoms at each time point: depression, pain, sense of well-being, and global ESAS scores. Symptoms improved to some degree with palliative care regardless of cognitive status.
However, at T7, mean global levels of symptom expression were lowest for patients with no delirium at either time point, followed by those with loss of delirium by T7. Patients with delirium at both time points, or who developed delirium in the first 7 days of treatment, showed higher mean global ESAS symptom scores at T7 than did patients without delirium at that point.
Even though palliative care led to symptom reductions for all groups, delirium remained associated with a more severe constellation of symptoms.
Mercadante S, Adile C, Ferrera P, Cortegiani A, Casuccio A. Symptom expression in patients with advanced cancer admitted to an acute supportive/palliative care unit with and without delirium [published online October 24, 2018]. Oncologist doi: 10.1634/theoncologist.2018-0244