Delirium in Advanced Cancer Patients

Delirium is a typical outcome in cases of advanced and chronic disease, such as cancer or HIV/AIDS. The mental status of delirium, which can occur suddenly, leads to decreased awareness, confusion, and agitation. It’s sometimes difficult to distinguish delirium from dementia. In general, dementia is an independent mental health condition, while delirium requires a contributing factor like stress, drug abuse, or severe illness. Delirium complicates medical treatment and often creates a decline in overall health, poor response to medications, slow recovery from surgery, and a greater risk of death. For these reasons, identification and treatment of delirium in its early phases is important.

Advanced terminal cancer is one such condition in which delirium is a frequent complication. A study underway in the Netherlands is hoping to clarify the best treatment practices for this vulnerable population. The study is recruiting patients who are admitted to the oncology ward at the VU University Medical Center or the Spaarne Hospital. Participants must voluntarily provide consent and meet the study’s inclusion criteria: a diagnosis of advanced cancer and age greater or equal to 18. Exclusion criteria include Parkinson’s disease, dementia, an interfering psychiatric diagnosis, a history of convulsions, or a history of substance abuse. The final estimated enrollment will be 300.

Upon admission to the study, each participant will be assessed on a standard delirium rating scale. Those who receive a confirmation of delirium will be randomized into one of two treatment groups. One group will receive the standard treatment of Haldol (haloperidol), a typical antipsychotic medication with a long history of relative success and safety. The other (experimental) group will receive Zyprexa (olanzapine), a newer and potentially more effective treatment. Both Haldol and Zyprexa were originally developed for treatment of schizophrenia, but their usage has expanded to include other mental health conditions. Haldol is sometimes associated with “movement disorders”—involuntary muscle movements in the face or extremities. As a newer, second-generation medication, Zyprexa has been shown to cause fewer harmful side effects; weight gain is the most common complaint.

Preventing delirium and shortening the length of delirium episodes is an important goal in the treatment of advanced cancer. The Netherlands study will reveal the relative effectiveness and safety of two important drugs for this purpose. Study authors believe that their results will point toward Zyprexa as the preferred treatment. Confirmation of that hypothesis will have to wait for the compiling of results, which won’t begin until February 2014.

References:

  1. Delirium. (n.d.). Mayo Clinic. Retrieved August 3, 2012, from http://www.mayoclinic.com/health/delirium/DS01064
  2. Early Recognition and Optimal Treatment of Delirium in Patients With Advanced Cancer. (n.d.). ClinicalTrials.gov. Retrieved August 3, 2012, from http://clinicaltrials.gov/ct2/show/NCT01539733?recr=Open&intr=%22Haloperidol%22&rank=9
  3. Haloperidol – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved August 3, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000604/
  4. Olanzapine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved August 3, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000161/

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