title: Delirium assessed by Memorial Delirium Assessment Scale in advanced cancer patients admitted to an acute palliative/supportive care unit.
abstract: Delirium is often unrecognized in cancer patients. The aim of this study was to investigate the prevalence of delirium assessed by the Memorial Delirium Assessment Scale (MDAS) and possible associated factors on admission to an acute palliative/supportive care unit (APSCU). The secondary outcome was to assess changes in MDAS and symptom burden at time of discharge.
  
  
  
  A consecutive sample of advanced cancer patients who were admitted to an APSCU was prospectively assessed for a period of 10 months. Patient demographics, including age, gender, primary diagnosis, Karnofsky status, stage of disease, and educational level were collected. The Edmonton Symptom Assessment Scale (ESAS) and the MDAS were measured at hospital admission and discharge.
  
  
  
  A total of 314 patients were surveyed. Of 292 patients with MDAS available at T0, 74 (25.3%) and 24 (8.2%) had a MDAS of 7-12 and ≥13, respectively. At discharge, there was a significant decrease in the number of patients with a MDAS ≥7/30. Higher values of MDAS were associated with age (p = .028), a lower Karnofsky status (p < .0005), gender (male, p = .04), low level of education (p = .002), less awareness of disease (p < .0005), more indications for end-of-life care admission (p < .0005) or other symptoms (p = .026), hospital stay (p = .038) and death (p < .0005). Significant decreases in ESAS were observed in all patients independently of MDAS values (p < .0005).
  
  
  
  Delirium is highly prevalent in patients admitted to APSCU, characterized by a low mortality due to early referral. Comprehensive assessment and treatment may allow a decrease in the level of cognitive disorders and symptom burden.
authors.affiliation: a Palliative Care program SAMO , Palermo , Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: b Department of Sciences for Health Promotion and Mother Child Care , University of Palermo , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Adile
authors.affiliation: a Palliative Care program SAMO , Palermo , Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferrera
authors.affiliation: c Department of Biopathology , Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico "P, Giaccone", University of Palermo , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cortegiani
authors.affiliation: b Department of Sciences for Health Promotion and Mother Child Care , University of Palermo , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casuccio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D017567:Karnofsky Performance Status; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D010351:Patient Discharge; D015995:Prevalence; D012017:Referral and Consultation
keywords: Advanced cancer; delirium; edmonton symptom assessment scale; memorial delirium assessment scale; palliative care