title: Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study.
abstract: Corticosteroids are often used to treat fatigue and anorexia, but occasionally produce delirium. Information on the predictors of delirium in corticosteroid-treated cancer patients remains limited.
  
  
  
  To identify potential factors predicting the development of delirium in corticosteroid-treated cancer patients.
  
  
  
  An exploratory, multicenter, prospective, observational study.
  
  
  
  Inclusion criteria for this study were patients who had metastatic or locally advanced cancer and a fatigue or anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale.
  
  
  
  Univariate and multivariable analyses were performed to identify the predictors of delirium diagnosed by the Confusion Assessment Method (CAM) within three days of initiation of corticosteroids.
  
  
  
  Among 207 patients administered corticosteroids, 35 (17%; 95% confidence interval [CI] 12%-23%) developed at least one episode of delirium diagnosed by the CAM. Factors predictive of the development of delirium were as follows: Palliative Performance Scale ≤20, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 4, the Support Team Assessment Schedule (STAS) score of drowsiness >1, concurrent opioid use, parenteral hydration volume ≤500 mL, and the absence of lung metastasis. A multivariable analysis identified the independent factors predicting responses as ECOG PS = 4 (odds ratio [OR] 4.0; 95% CI 1.7-9.3), STAS score of drowsiness >1 (OR 3.4; 95% CI 1.4-8.2), and concurrent opioid use (OR 3.7; 95% CI 1.0-13).
  
  
  
  Delirium in corticosteroid-treated advanced cancer patients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.
authors.affiliation: 1 Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital , Akita, Japan .
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuo
authors.affiliation: 2 Palliative and Supportive care Division, Seirei Mikatahara General Hospital , Hamamatsu, Japan .
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: 3 Department of Psychosomatic Internal Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center , Sakai, Japan .
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: 4 Palliative Medicine, Showa University Northern Yokohama Hospital , Yokohama, Japan .
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: 5 Department of Palliative Medicine, National Cancer Center Hospital East , Kashiwa, Japan .
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: 6 Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center , Tokyo, Japan .
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kaneishi
authors.affiliation: 7 Komaki City Hospital , Komaki, Japan .
authors.forename: Takuya
authors.initials: T
authors.lastname: Odagiri
authors.affiliation: 8 Department of Palliative Care and Pain Management, Cancer Institute Hospital , Tokyo, Japan .
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: 9 NHO Yamaguchi-Ube Medical Center , Ube, Japan .
authors.forename: Hideki
authors.initials: H
authors.lastname: Katayama
authors.affiliation: 10 Gratia hospital hospice , Mino, Japan .
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mori
authors.affiliation: 11 Seirei Hamamatsu General Hospital , Hamamatsu, Japan .
authors.forename: Hirohide
authors.initials: H
authors.lastname: Yamada
authors.affiliation: 7 Komaki City Hospital , Komaki, Japan .
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: 12 Department of Palliative Medicine, Yokohama Municipal Citizens Hospital , Yokohama, Japan .
authors.forename: Taro
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: 13 Department of Palliative Medicine, Kobe University Graduate School of Medicine , Kobe, Japan .
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: 14 Kawasaki Municipal Ida Hospital , Kawasaki, Japan .
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishi
authors.affiliation: 15 Seirei Mikatahara General Hospital , Hamamatsu, Japan .
authors.forename: Akemi
authors.initials: A
authors.lastname: Shirado
authors.affiliation: 16 Department of Oncology, Mitsubishi Kyoto Hospital , Kyoto, Japan .
authors.forename: Shuji
authors.initials: S
authors.lastname: Hiramoto
authors.affiliation: 17 Toyama Prefectural Central Hospital , Toyama, Japan .
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: 18 Department of Palliative Care, Hiroshima Prefectural Hospital , Hiroshima, Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kohara
authors.affiliation: 19 Department of Palliative Care, Aichi Cancer Center Hospital , Nagoya, Japan .
authors.forename: Satofumi
authors.initials: S
authors.lastname: Shimoyama
authors.affiliation: 20 Department of Palliative medicine, Teikyo University School of Medicine , Tokyo, Japan .
authors.forename: Etsuko
authors.initials: E
authors.lastname: Aruga
authors.affiliation: 21 Palliative care Division, Saito Yukoukai Hospital , Osaka, Japan .
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: 22 Matsue City Hospital , Matsue, Japan .
authors.forename: Koki
authors.initials: K
authors.lastname: Sumita
authors.affiliation: 23 Research Hospital, The Institute of Medical Science, The University of Tokyo , Tokyo, Japan .
authors.forename: Satoru
authors.initials: S
authors.lastname: Iwase
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology; D015897:Comorbidity; D003693:Delirium / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D064887:Observational Studies as Topic; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D019452:Terminally Ill / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: cancer; corticosteroids; palliative care; predictors