Palliative care program SAMO and University of Palermo, Palermo, Italy.
Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy.
Support Care Cancer. 2018 Mar;26(3):913-919. doi: 10.1007/s00520-017-3910-6. Epub 2017 Oct 5.
The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care.
A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7).
Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2-220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7.
Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This information is relevant for decision-making when delirium does not change despite a traditional intervention. Continuous assessment of delirium should be performed in these settings to detect deterioration of cognitive function. Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease.
本研究旨在评估意大利不同姑息治疗服务机构收治的晚期癌症患者发生谵妄的患病率及可能相关因素。次要结局为评估姑息治疗 1 周后谵妄的变化。
在 1 年期间，7 家姑息治疗服务机构对连续样本患者进行谵妄筛查。收集一般资料，包括原发肿瘤、年龄、性别、合并症、姑息预后评分（PaP）和卡诺夫斯基状态。寻找与谵妄相关的可能原因或因素。入院时（T0）和姑息治疗 1 周后（T7）使用埃德蒙顿症状评估量表（Edmonton Symptom Assessment Scale）评估患者的躯体和心理症状，使用谵妄评估量表（Memorial Delirium Assessment Scale，MDAS）评估患者的认知状态。
在筛查的 848 例患者中，有 263 例患者接受了评估。66 例患者仅接受了初始评估。卡诺夫斯基状态平均为 34.1（SD=6.69）；入院时 PaP 评分平均为 6.9（SD=3.97）。姑息治疗援助的平均持续时间（相当于生存时间）为 38.4 天（SD=48，范围 2-220）。入院时和姑息治疗 1 周后 MDAS 值分别为 6.9（SD=6.71）和 8.8（SD=8.26）。入院时 MDAS 值≥7 的患者有 110 例（41.8%），姑息治疗 1 周后 MDAS 值≥7 的患者有 167 例（67.3%）。年龄、脱水、恶病质、近 3 个月化疗以及嗜睡和呼吸困难程度与 MDAS 值>7 独立相关。嗜睡加重、使用阿片类药物和使用皮质类固醇与 T0 至 T7 期间 MDAS 的变化独立相关。
尽管谵妄的患病率似乎与其他急性环境中报道的相似，但谵妄往往会恶化或对姑息治疗反应不佳。一些临床因素与谵妄独立相关。当谵妄尽管进行了传统干预但仍未改善时，这些信息对于决策很重要。在这些情况下，应持续评估谵妄，以发现认知功能恶化。进一步的研究应阐明在疾病晚期早期进行姑息治疗是否会降低谵妄的发生率。
