Predictive factors for incidence of terminal delirium in patients with cancer admitted to inpatient palliative care units

• Project/Area Number: 16K15560
• Research Category: Grant-in-Aid for Challenging Exploratory Research
• Allocation Type: Multi-year Fund
• Research Field: Psychiatric science
• Research Institution: Seirei Christopher University (2017-2019); Osaka City University (2016)
• Principal Investigator: Maeda Isseki 聖隷クリストファー大学, 看護学研究科, 臨床講師 (70706639)
• Co-Investigator(Kenkyū-buntansha): 小川 朝生 国立研究開発法人国立がん研究センター, 先端医療開発センター, 分野長 (10466196) ; 森 雅紀 聖隷クリストファー大学, 看護学研究科, 臨床講師 (10771868) ; 羽多野 裕 京都府立医科大学, 医学(系)研究科(研究院), 客員講師 (30516034)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥3,380,000 (Direct Cost: ¥2,600,000、Indirect Cost: ¥780,000); Fiscal Year 2018: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2017: ¥1,950,000 (Direct Cost: ¥1,500,000、Indirect Cost: ¥450,000); Fiscal Year 2016: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
• Keywords: 終末期せん妄 / 予測因子 / 緩和医療 / せん妄

Outline of Final Research Achievements

Delirium is a distressing symptom frequently occurred in terminally-ill patients. The prevalence of this condition is reported to be 50-80%; patients with delirium often need palliative sedation therapy. In this study, we obtained day-to-day clinical data of terminally-ll cancer patients who admitted to inpatient palliative care unit and tried to develop predictive models for identifying patients who develop hyper-active delirium in final days of their life. Data from 1896 patients were obtained. Hyper-active delirium in the terminal phase was observed in 31.9%. Random forest method was employed using patient characteristics, symptoms, medical treatment during the end-of-lie phase as exploratory variables. Patient age, opioid consumption, hydration volume, and pain severity were detected as predictive variables for the occurrence of hyperactive delirium in terminal phase.

Academic Significance and Societal Importance of the Research Achievements

本研究はこれまで大規模なデータが得られなかった終末期せん妄に関して、緩和ケア病棟に入院した後の経時的な変化を含むデータを得て、終末期の過活動せん妄の発症危険因子の分析を行った研究である。本研究により、終末期に苦痛の多い過活動せん妄を発症する患者の予測が可能となり、同じようなリスクを有する患者のケアの質が向上するものと思われる。また経時的に測定された症状、治療、アウトカムデータを用いて、Random Forest法を適応し、臨床的な適応可能性の高い結果が得られることも示された。

Research Products

• [Journal Article] The Functional Palliative Prognostic Index: a scoring system for functional prognostication of patients with advanced cancer. (2020)
  • Author(s): Hiratsuka Y, Yamaguchi T, Maeda I, Morita T, Mori M, Yokomichi N, Hiramoto S, Matsuda Y, Kohara H, Suzuki K, Tagami K, Yamaguchi T, Inoue A.
  • Journal Title: Support Care Cancer Volume: Epub ahead of print Issue: 12 Pages: 6067-6074
  • DOI: 10.1007/s00520-020-05408-x
  • Peer Reviewed / Int'l Joint Research