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

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  • Kawashima Natsuki
    Department of Palliative Medicine, Tsukuba Medical Center Hospital
  • Hisanaga Takayuki
    Department of Palliative Medicine, Tsukuba Medical Center Hospital
  • Hamano Jun
    Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba
  • Maeda Isseki
    Gratia Hospice, Gratia Hospital
  • Imai Kengo
    Seirei Hospice, Seirei Mikatahara General Hospital
  • Sakashita Akihiro
    Department of Palliative Medicine, Kobe University School of Medicine
  • Matsumoto Yoshihisa
    Department of Palliative Medicine, National Cancer Center Hospital East
  • Uemura Keiichi
    Department of Psychiatry, National Hospital Organization Hokkaido Medical Center
  • Odagiri Takuya
    Department of Palliative Care, Komaki City Hospital
  • Ogawa Asao
    Department of Psycho-Oncology Service, National Cancer Center Hospital East
  • Yoshiuchi Kazuhiro
    Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo
  • Iwase Satoru
    Department of Palliative Medicine, Saitama Medical University

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  • 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

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Abstract

<p>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.</p>

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