Terminal Anguish among Delirious Patients with Advanced Cancer: A Multicenter, Prospective, Observational Study

Natsuki Kawashima; Takayuki Hisanaga; Jun Hamano; Isseki Maeda; Kengo Imai; Akihiro Sakashita; Yoshihisa Matsumoto; Keiichi Uemura; Takuya Odagiri; Asao Ogawa; Kazuhiro Yoshiuchi; Satoru Iwase

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Terminal Anguish among Delirious Patients with Advanced Cancer: A Multicenter, Prospective, Observational Study

VernacularTitle:せん妄を呈した進行がん患者における苦悩の実態：多施設前向き観察研究
Author: Natsuki KAWASHIMA ¹ ; Takayuki HISANAGA ¹ ; Jun HAMANO ² ; Isseki MAEDA ³ ; Kengo IMAI ⁴ ; Akihiro SAKASHITA ⁵ ; Yoshihisa MATSUMOTO ⁶ ; Keiichi UEMURA ⁷ ; Takuya ODAGIRI ⁸ ; Asao OGAWA ⁹ ; Kazuhiro YOSHIUCHI ¹⁰ ; Satoru IWASE ¹¹
Author Information

1. Department of Palliative Medicine, Tsukuba Medical Center Hospital
2. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba
3. Gratia Hospice, Gratia Hospital
4. Seirei Hospice, Seirei Mikatahara General Hospital
5. Department of Palliative Medicine, Kobe University School of Medicine
6. Department of Palliative Medicine, National Cancer Center Hospital East
7. Department of Psychiatry, National Hospital Organization Hokkaido Medical Center
8. Department of Palliative Care, Komaki City Hospital
9. Department of Psycho-Oncology Service, National Cancer Center Hospital East
10. Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo
11. Department of Palliative Medicine, Saitama Medical University
Keywords: terminal; anguish; delirium; severity; antipsychotics
From:Palliative Care Research 2019;14(3):237-243
CountryJapan
Language:Japanese
Abstract: Objective: This study aimed to reveal the prevalence and characteristics of anguish among delirious patients with advanced cancer receiving specialized palliative care services. Methods: We conducted a subanalysis of a multicenter, prospective, observational study at 14 inpatient palliative care units and 10 general wards that offered psycho-oncology consultation service in Japan. We consecutively enrolled the patients with advanced cancer who were diagnosed with delirium and prescribed antipsychotics. Palliative care specialists decided whether patients suffered from anguish or not. We assessed patients’ background and severity of delirium with the Delirium Rating Scale-Revised (DRS-R-98). Results: Of 818 enrolled patients, 99 (12.1%) suffered from anguish. We observed a significant difference in the mean age (68.9±12.6 vs. 72.1±11.2, p=0.009), prevalence of dementia (2% vs. 10.4%, p=0.005) between patients with anguish and those without anguish. Patients with anguish had lower DRS-R-98 total scores before medication than those without anguish (15.3±8.1 vs. 17.3±7.8, p=0.018), but higher severity score in lability of affect (1.2±0.8 vs 1.0±0.9, p=0.023). Conclusions: The results of this study suggested that patients with anguish tend to be younger, mostly do not have dementia, and have lower delirium severity score but higher score in lability of affect. Nevertheless, further research, investigating appropriate evaluations and medical interventions for patients with anguish is warranted.