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Published in: Supportive Care in Cancer 5/2012

01-05-2012 | Original Article

Delirium in patients with head and neck cancer in the outpatient treatment setting

Authors: Stewart M. Bond, Mary S. Dietrich, John L. Shuster Jr., Barbara A. Murphy

Published in: Supportive Care in Cancer | Issue 5/2012

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Abstract

Purpose

Delirium is a common neurocognitive disorder among patients with cancer. In patients with head and neck cancer, delirium has been examined in the postoperative setting. Because no studies have reported on delirium during outpatient cancer treatment, we conducted a prospective study in 69 patients with head and neck cancer to examine neurocognitive function before, during, and after outpatient treatment. We also conducted a retrospective study in a subset of caregivers. In this paper, we report the prevalence and incidence of delirium and subsyndromal delirium (SSD) during outpatient treatment.

Methods

Assessments were conducted before treatment, at scheduled treatment visits, and at a 3-month post-treatment visit. Delirium and SSD were assessed using the Confusion Assessment Method (CAM). Following treatment, we retrospectively asked patients (n = 58) and a subset of caregivers (n = 23) whether patients experienced delirium during treatment.

Results

Based on CAM assessments at scheduled treatment visits, six patients (8.6%) developed delirium during treatment. Additionally, 31% of patients and 43.5% of caregivers retrospectively reported delirium. The prevalence and incidence of SSD were 7.2% and 45.3%, respectively.

Conclusions

These data suggest that delirium and SSD are frequent in patients with head and neck cancer undergoing outpatient treatment. Delirium was often associated with medical complications. The potential impact of delirium and SSD on treatment outcomes, recovery, and caregiving are significant clinical concerns.
Literature
1.
go back to reference Inouye SK (1998) Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol 11:118–125PubMed Inouye SK (1998) Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol 11:118–125PubMed
3.
go back to reference Lipowski ZJ (1990) Delirium: acute confusional states. Oxford University Press, London Lipowski ZJ (1990) Delirium: acute confusional states. Oxford University Press, London
10.
11.
go back to reference Levkoff SE, Liptzin B, Cleary PD, Wetle T, Evans DA, Rowe JW, Lipsitz LA (1996) Subsyndromal delirium. Am J Geriatric Psych 4:320–329 Levkoff SE, Liptzin B, Cleary PD, Wetle T, Evans DA, Rowe JW, Lipsitz LA (1996) Subsyndromal delirium. Am J Geriatric Psych 4:320–329
16.
go back to reference Wang S, Goh E, Lee B, Chon K (2004) Factors associated with postoperative delirium after major head and neck surgery. Ann Otol Rhinol Laryngol 113:48–51PubMed Wang S, Goh E, Lee B, Chon K (2004) Factors associated with postoperative delirium after major head and neck surgery. Ann Otol Rhinol Laryngol 113:48–51PubMed
19.
20.
go back to reference Meyers CA, Albitar M, Estey E (2005) Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 104:788–793PubMedCrossRef Meyers CA, Albitar M, Estey E (2005) Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 104:788–793PubMedCrossRef
21.
go back to reference Vardy JL, Dhillon H, Xu W, Dodd A, Park A, Rourke SB, Clarke SJ, Ringash J, Burkes R, Tannock IF (2009) Cognitive function and fatigue in colorectal cancer (CRC) patients: baseline assessments prior to chemotherapy. J Clin Oncol 27:497s, Meeting Abstracts Vardy JL, Dhillon H, Xu W, Dodd A, Park A, Rourke SB, Clarke SJ, Ringash J, Burkes R, Tannock IF (2009) Cognitive function and fatigue in colorectal cancer (CRC) patients: baseline assessments prior to chemotherapy. J Clin Oncol 27:497s, Meeting Abstracts
23.
go back to reference Inouye S, Van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948PubMed Inouye S, Van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948PubMed
24.
go back to reference Neelon VJ, Champagne MT, Carlson JR, Funk SG (1996) The Neecham Confusion Scale: construction, validation, and clinical testing. Nurs Res 45:324–330PubMedCrossRef Neelon VJ, Champagne MT, Carlson JR, Funk SG (1996) The Neecham Confusion Scale: construction, validation, and clinical testing. Nurs Res 45:324–330PubMedCrossRef
25.
go back to reference Folstein M, Folstein S, Fanjiang G (2001) Mini-mental state examination: clinical guide and user's guide. Psychological Assessment Resources, Lutz Folstein M, Folstein S, Fanjiang G (2001) Mini-mental state examination: clinical guide and user's guide. Psychological Assessment Resources, Lutz
26.
go back to reference Bruera E, Bush SH, Willey J, Paraskevopoulos T, Li Z, Palmer JL, Cohen MZ, Sivesind D, Elsayem A (2009) Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer 115:2004–2012. doi:10.1002/cncr.24215 PubMedCrossRef Bruera E, Bush SH, Willey J, Paraskevopoulos T, Li Z, Palmer JL, Cohen MZ, Sivesind D, Elsayem A (2009) Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer 115:2004–2012. doi:10.​1002/​cncr.​24215 PubMedCrossRef
27.
29.
go back to reference Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA (2010) Delirium in elderly patients and the risk of post-discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451. doi:10.1001/jama.2010.1013 PubMedCrossRef Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA (2010) Delirium in elderly patients and the risk of post-discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451. doi:10.​1001/​jama.​2010.​1013 PubMedCrossRef
30.
go back to reference Buss MK, Vanderwerker LC, Inouye SK, Zhang B, Block SD, Prigerson HG (2007) Associations between caregiver-perceived delirium in patients with cancer and generalized anxiety in their caregivers. J Palliat Med 10:1083–1092. doi:10.1089/jpm.2006.0253 PubMedCrossRef Buss MK, Vanderwerker LC, Inouye SK, Zhang B, Block SD, Prigerson HG (2007) Associations between caregiver-perceived delirium in patients with cancer and generalized anxiety in their caregivers. J Palliat Med 10:1083–1092. doi:10.​1089/​jpm.​2006.​0253 PubMedCrossRef
Metadata
Title
Delirium in patients with head and neck cancer in the outpatient treatment setting
Authors
Stewart M. Bond
Mary S. Dietrich
John L. Shuster Jr.
Barbara A. Murphy
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 5/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1174-0

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