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RESEARCH PRODUCT

Symptom Expression in Patients with Advanced Cancer Admitted to an Acute Supportive/Palliative Care Unit With and Without Delirium

Claudio AdilePatrizia FerreraSebastiano MercadanteAndrea CortegianiAlessandra Casuccio

subject

MaleCancer Researchmedicine.medical_specialtyWeaknessPalliative careNauseaNeuropsychological TestsSeverity of Illness Indexbehavioral disciplines and activities03 medical and health sciencesCognition0302 clinical medicineAdvanced cancerNeoplasmsInternal medicinemental disordersHumansMedicineProspective Studies030212 general & internal medicineKarnofsky Performance StatusDepression (differential diagnoses)Edmonton Symptom Assessment ScaleAgedNeoplasm StagingPain MeasurementDepressionbusiness.industryPalliative CareDeliriumCancerMemorial Delirium Assessment ScaleCancer PainMiddle Agedmedicine.diseaseAdvanced cancernervous system diseasesHospitalizationTreatment OutcomeOncologySymptom Management and Supportive Care030220 oncology & carcinogenesisBehavior Rating ScaleAnxietyDeliriumFemaleSymptom Assessmentmedicine.symptombusiness

description

Abstract Aim The aim of this study was to investigate the relationship between delirium and symptom expression in patients with advanced cancer admitted to an acute supportive/palliative care unit (ASPCU). Methods A consecutive sample of patients with advanced cancer who were admitted to an ASPCU was prospectively assessed for a period of 10 months. The Edmonton Symptom Assessment Scale (ESAS) and the MDAS (Memorial Delirium Assessment Scale) were measured at admission (T0) and after 7 days of palliative care (T7). Results Two hundred forty-six patients had complete data regarding MDAS measurements, at either T0 and T7. Of these, 75 (30.5%) and 63 patients (25.6%) had delirium at T0 and after a week of palliative care (T7), with a decrease in the frequency of delirium of 4.9% (from 30.5% to 25.6%); that means that 16% of patients with delirium improved their cognitive status after initiation of palliative care. Intensities of pain, depression, poor well-being, and global ESAS were significantly higher in patients with delirium. Patients who did not have delirium at T0 but developed delirium during admission after 1 week of palliative care had a higher level of symptom expression for pain, weakness, nausea, anxiety, dyspnea, appetite, and consequently global ESAS. Patients who did not develop delirium at any time had a relevant decrease in intensity of all ESAS items after 1 week of palliative care. The decrease of symptom intensity was significant for pain, insomnia, appetite, poor well-being, and global ESAS in patients with delirium either at T0 and T7, although these differences were less relevant than those observed in patients without delirium. In patients with delirium at T0 who improved their cognitive function at T7 (no delirium), significant changes were found in most ESAS items. Conclusion Symptom expression is amplified in patients with delirium, whereas patients without delirium may be more responsive to palliative treatments with a significant decrease in intensity of ESAS items.

yearjournalcountryeditionlanguage
2018-04-20The Oncologist
https://doi.org/10.1634/theoncologist.2018-0244