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Llisterri-Sánchez P, Benlloch M, Pérez-Ros P. The Confusion Assessment Method Could Be More Accurate than the Memorial Delirium Assessment Scale for Diagnosing Delirium in Older Cancer Patients: An Exploratory Study. Curr Oncol 2023; 30:8245-8254. [PMID: 37754513 PMCID: PMC10529689 DOI: 10.3390/curroncol30090598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Older people with cancer carry a high risk of delirium, an underdiagnosed syndrome due to its diagnostic complexity and often subtle presentation. Tools based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) are available to different health professionals. Our aim is to assess the prevalence of delirium in older people with cancer in an inpatient unit and the accuracy of the Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS). METHODS This exploratory, cross-sectional study included people aged 65 years or older with a diagnosis of cancer and admitted to the medical oncology unit from June 2021 to December 2022. The diagnostic accuracy of CAM and MDAS was analyzed against the gold standard medical diagnosis based on DSM-5 criteria by two medical oncologists. The cutoff point for the MDAS was determined using a receiver-operating characteristics (ROC) curve. RESULTS Among the 75 included patients (mean age 71.6 years, standard deviation 4.1; 52% males), the prevalence of delirium was 62.7%. The most prevalent types of cancer in patients with delirium were hematological and lung cancer. The scale with the highest diagnostic accuracy was the CAM, with a sensitivity of 100% and specificity of 86%, followed by the MDAS, with a sensitivity of 88% and specificity of 30%. The presence of cognitive impairment hindered the detection of delirium. CONCLUSIONS The CAM scale was more accurate than the MDAS pre-existing cognitive impairment in our sample. Further studies are needed to analyze the diagnostic accuracy of delirium tools in older populations with cancer and in the presence of cognitive impairment.
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Affiliation(s)
- Paula Llisterri-Sánchez
- Doctoral School, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain
- Coordinación Hospitalización, Hospital Intermutual de Levante, Km 11,7 CV-35, San Antonio de Benagéber, 46184 Valencia, Spain
| | - María Benlloch
- Department of Basic Biomedical Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Pilar Pérez-Ros
- Department of Nursing, Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
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Martínez-Arnau FM, Puchades-García A, Pérez-Ros P. Accuracy of Delirium Screening Tools in Older People with Cancer-A Systematic Review. Cancers (Basel) 2023; 15:2807. [PMID: 37345143 DOI: 10.3390/cancers15102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The increase in life expectancy worldwide has led to a larger population of older people, which in turn entails a rising prevalence of cancer. One of the main complications of cancer is delirium, especially in advanced stages. OBJECTIVE To determine which delirium screening instrument is the most accurate in older people with cancer. METHODS A systematic review was designed. A literature search was performed in MEDLINE, EBSCO and SCOPUS; additional records were identified by handsearching. Selection criteria were studies involving people with cancer and a mean sample age of 60 years or older, assessing delirium, and reporting the metric properties of the assessment instrument. Studies with post-surgical patients and substance abuse delirium were excluded. RESULTS From 2001 to 2021, 14 eligible studies evaluated 13 different assessment tools, reporting an incidence of delirium ranging from 14.3% to 68.3%. The Delirium Observation Screening Scale (DOSS) showed the best metric properties, followed by the Nursing Delirium Screening Scale (NuDESC), Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS). Only two studies were considered to be at low risk of bias using the QUADAS-2 Tool. No study exclusively examined this population group. CONCLUSIONS Screening tools for delirium are heterogeneous for older people with cancer, and there is a need to analyze metric properties exclusively in the older population. Registered on PROSPERO ID: CRD42022303530.
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Affiliation(s)
- Francisco Miguel Martínez-Arnau
- Department of Physiotherapy, Universitat de València, Gascó Oliag 5, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
| | - Andrea Puchades-García
- Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
| | - Pilar Pérez-Ros
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
- Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, Menendez Pelayo s/n, 46010 Valencia, Spain
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Klankluang W, Tongsai S, Sriphirom C, Siriussawakul A, Chanthong P, Tayjasanant S. The prevalence, associated factors, clinical impact, and state of diagnosis of delirium in palliative care patients. Support Care Cancer 2021; 29:7949-7956. [PMID: 34213642 PMCID: PMC8550445 DOI: 10.1007/s00520-021-06367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
Purpose The aim of this study is to establish the prevalence, associated factors, and clinical impact of delirium in newly referred palliative care patients and the percentage of delirium diagnoses missed by primary medical teams. Methods Newly referred palliative care patients were evaluated and were reviewed for possible associated factors of delirium. Univariable and multivariable analysis were used to identify associated factors. Median overall survival and survival curves were analyzed. The percentage of missed diagnosis in IPD patients was identified. Results We included 350 palliative care patients. Nearly all patients had cancer diagnosis (96.6%). The overall prevalence of delirium was 44.0%. The independent associated factors of delirium were age ≥ 63 years (adjusted odds ratio [aOR], 7.0; 95% CI, 2.2–22.9), palliative performance scale ≤ 20% (aOR, 54.5; 95% CI, 13.1–228.0), brain metastasis (aOR, 15.6; 95% CI, 3.7–66.7), urinary tract infection (aOR, 18.8; 95% CI, 4.7–75.5), sepsis (aOR, 59.0; 95% CI, 4.4–797.8), hyponatremia (aOR, 8.8; 95% CI, 2.6–29.8), and hypercalcemia (not applicable). Interestingly, opioids and benzodiazepines were not associated with delirium. Delirious patients had significantly shorter survival (median survival 11 days). Delirium diagnoses were missed for 76.1%. Conclusion Nearly half of the palliative care patients had delirium, which was associated with noticeably short survivals. We identified the independent factors associated with the delirium. Despite having a remarkably high prevalence rate and being a well-known poor prognostic factor, there was still a very high rate of missed delirium diagnoses. Effective, routine, delirium screening of palliative care patients needs to be emphasized.
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Affiliation(s)
- Watanachai Klankluang
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi, Bangkok, 10700, Thailand
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chairat Sriphirom
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi, Bangkok, 10700, Thailand
| | - Arunotai Siriussawakul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pratamaporn Chanthong
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi, Bangkok, 10700, Thailand
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi, Bangkok, 10700, Thailand.
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Watt CL, Scott M, Webber C, Sikora L, Bush SH, Kabir M, Boland JW, Woodhouse R, Sands MB, Lawlor PG. Delirium screening tools validated in the context of palliative care: A systematic review. Palliat Med 2021; 35:683-696. [PMID: 33588640 DOI: 10.1177/0269216321994730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Delirium is a distressing neuropsychiatric disorder affecting patients in palliative care. Although many delirium screening tools exist, their utility, and validation within palliative care settings has not undergone systematic review. AIM To systematically review studies that validate delirium screening tools conducted in palliative care settings. DESIGN Systematic review with narrative synthesis (PROSPERO ID: CRD42019125481). A risk of bias assessment via Quality Assessment Tool for Diagnostic Accuracy Studies-2 was performed. DATA SOURCES Five electronic databases were systematically searched (January 1, 1982-May 3, 2020). Quantitative studies validating a screening tool in adult palliative care patient populations were included. Studies involving alcohol withdrawal, critical or perioperative care were excluded. RESULTS Dual-reviewer screening of 3749 unique titles and abstracts identified 95 studies for full-text review and of these, 17 studies of 14 screening tools were included (n = 3496 patients). Data analyses revealed substantial heterogeneity in patient demographics and variability in screening and diagnostic practices that limited generalizability between study populations and care settings. A risk of bias assessment revealed methodological and reporting deficits, with only 3/17 studies at low risk of bias. CONCLUSIONS The processes of selecting a delirium screening tool and determining optimal screening practices in palliative care are complex. One tool is unlikely to fit the needs of the entire palliative care population across all palliative care settings. Further research should be directed at evaluating and/or adapting screening tools and practices to fit the needs of specific palliative care settings and populations.
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Affiliation(s)
- Christine L Watt
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Mary Scott
- Bruyère Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Colleen Webber
- Bruyère Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lindsey Sikora
- University of Ottawa, Health Sciences Library, Ottawa, ON, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rebecca Woodhouse
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Megan B Sands
- University of New South Wales Prince of Wales Clinical School, Randwick, NSW, Australia
| | - Peter G Lawlor
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Mercadante S, Adile C, Tirelli W, Ferrera P, Penco I, Casuccio A. Aberrant opioid use behaviour in advanced cancer. BMJ Support Palliat Care 2020; 12:107-113. [PMID: 33355216 DOI: 10.1136/bmjspcare-2020-002606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the presence of aberrant behaviour in a consecutive sample of patients with advanced cancer treated with opioids in a country like Italy, with its peculiar attitudes towards the use opioids. The second objective was to detect the real misuse of opioids in clinical practice. METHODS Prospective observational study in two palliative care units in Italy in a period of 6 months. At admission the Edmonton Symptom Assessment Scale, the Memorial Delirium Assessment Scale, Brief Pain Inventory (BPI) and the Hospital Anxiety Depression Scale were measured. For detecting the risk of aberrant opioid use, the Screener and Opioid Assessment for Patients With Pain (SOAAP), the Opioid Risk Tool (ORT), the Cut Down-Annoyed-Guilty-Eye Opener (CAGE) questionnaire adapted to include drug use (CAGE-AID) were used. Aberrant behaviours displayed at follow-up within 1 month were recorded. RESULTS One-hundred and thirteen patients with advanced cancer were examined. About 35% of patients were SOAPP positive. There was correlation between SOAPP, CAGE-AID and ORT. SOAPP was independently associated with a lower Karnofsky level, pain intensity, poor well-being, BPI pain at the moment. No patient displayed aberrant behaviours, despite having a moderate-high risk. CONCLUSIONS Despite a high percentage of patients showed a high risk of aberrant behaviours, no patient displayed clinical aberrant behaviours after 1 month-follow-up. This does not exempt from continuous monitoring for patients who are at risk.
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Affiliation(s)
- Sebastiano Mercadante
- Main regional center for Pain Relief and Palliative/supportive Care La Maddalena cancer Center Palermo, Palermo, Sicilia, Italy
| | - Claudio Adile
- Main regional center for Pain Relief and Palliative/supportive Care La Maddalena cancer Center Palermo, Palermo, Sicilia, Italy
| | | | - Patrizia Ferrera
- Main regional center for Pain Relief and Palliative/supportive Care La Maddalena cancer Center Palermo, Palermo, Sicilia, Italy
| | | | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Sicilia, Italy
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Mercadante S, Adile C, Tirelli W, Ferrera P, Penco I, Casuccio A. Barriers and Adherence to Pain Management in Advanced Cancer Patients. Pain Pract 2020; 21:388-393. [PMID: 33200548 DOI: 10.1111/papr.12965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
AIM To assess patients' barriers to pain management and analgesic medication adherence in patients with advanced cancer. METHODS This was a prospective cross-sectional study in patients with advanced cancer receiving chronic opioid therapy. Age, gender, cancer diagnosis, Karnofsky level, and educational status were recorded. The Brief Pain Inventory (BPI), Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale (MDAS), Barriers Questionnaire II (BQ-II), Medication Adherence Rating Scale (MARS), and Hospital Anxiety and Depression Scale (HADS) were the measurement instruments used. RESULTS One-hundred-thirteen patients were analyzed. The mean age was 68 (±13) years, and 59 (52%) were male. The mean Karnofsky status was 51.4 (standard deviation [SD] 11.5). The mean score for BQ-II items was 1.77 (SD 0.7). The BQ-II score was independently related to the HADS-Depression score (P = 0.033) and the total HADS score (P = 0.049). Negative side-effects and attitudes toward psychotropic medication globally prevailed among MARS items. These items were independently associated with gender (P = 0.030), pain (P = 0.003), and depression (P = 0.047). CONCLUSION Barriers to pain management were mild. Psychological factors such as depression were the main factor associated with barriers. Poor adherence to analgesic medication was mostly manifested as negative side-effects and attitudes toward psychotropic medication, was more frequent observed in females, and was associated with the ESAS items pain and depression.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | - Claudio Adile
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | | | - Patrizia Ferrera
- Main Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center Palermo, Palermo, Italy
| | | | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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