Evidence map›Paper›PMID 30610009›Full record

ArticleThe oncologist2019

Current Pharmacotherapy Does Not Improve Severity of Hypoactive Delirium in Patients with Advanced Cancer: Pharmacological Audit Study of Safety and Efficacy in Real World (Phase-R).

Toru Okuyama, Kazuhiro Yoshiuchi, Asao Ogawa, Satoru Iwase, Naosuke Yokomichi, Akihiro Sakashita, Keita Tagami, Keiichi Uemura, Rika Nakahara, Tatsuo Akechi and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The oncologist, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Observational
  3. Article
  4. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Toru OkuyamaDivision of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
Kazuhiro YoshiuchiDepartment of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
Asao OgawaDepartment of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan.
Satoru IwaseDepartment of Palliative Medicine, Saitama Medical University, Morohongo Moroyama-machi, Iruma-gun, Saitama, Japan.
Naosuke YokomichiSeirei Hospice, Seirei Mikatahara General Hospital, Mikatahara-cho, kita-ku, Hamamatsu, Shizuoka, Japan.
Akihiro SakashitaDepartment of Palliative Medicine, Kobe University Graduate School of Medicine, Kusunoki-cho, chuoh-ku, Kobe, Hyogo, Japan.
Keita TagamiDepartment of Palliative Medicine, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
Keiichi UemuraDepartment of Psychiatry, Hokkaido Medical Center, Yamanote, Nishi-ku, Sapporo, Hokkaido, Japan.
Rika NakaharaDepartment of Psycho-Oncology, National Cancer Center Hospital, Tsukiji, Chuou-ku, Tokyo, Japan.
Tatsuo AkechiDivision of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan takechi@med.nagoya-cu.ac.jp.
Phase‐R Delirium Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy. SUBJECTS, MATERIALS, AND

methodsWe included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2).

resultsAvailable data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy.

conclusionCurrent pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure. IMPLICATIONS FOR PRACTICE: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.

Indexed as

AdultAgedAged, 80 and overAntipsychotic AgentsDeliriumFemaleHumansMaleMedical AuditMiddle AgedNeoplasmsProspective StudiesAntipsychotic AgentsAntipsychotic agentsDeliriumNeoplasmsPalliative carePharmacovigilance

Identifiers

PMID30610009
PMCPMC6656448

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.