Pharmacological Strategies for Pain Relief in Patients with Terminal Delirium: A Secondary Data Analysis.

BACKGROUND

Terminally ill cancer patients often experience pain and delirium. However, opioids administered for pain management may exacerbate patients' delirium.

OBJECTIVES

To explore the real-world symptom trajectory associated with pharmacological interventions, including opioids and antipsychotics, in patients with cancer pain and terminal delirium.

DESIGN

A secondary analysis of a multicenter prospective observational study.

SETTING/SUBJECTS: Adult patients admitted to inpatient hospice or palliative care units in Japan. Participants were eligible if they had cancer pain (Integrated Palliative care Outcome Scale: IPOS ≥2) and delirium at the time that their Palliative Performance Scale had declined to ≤20 (day 1, immediately before death).

MEASUREMENTS: Pharmacological strategies, pain levels (using the IPOS), and delirium symptoms (using the Memorial Delirium Assessment Scale, item-9).

RESULTS

Among a total of 1896 patients, 1396 were assessed for eligibility on day 1, and 137 met the inclusion criteria for analysis. A total of 86 (63%) patients had agitated delirium (hyperactive or mixed) with a median survival time of three days. Regarding pharmacological strategies, 32 (23%) received opioid initiation/dose escalation and 94 (69%) received regular administration of antipsychotics. These figures also included 25 (18%) patients who received both opioid initiation/dose escalation and antipsychotics. Approximately 55% of all patients had persistent cancer pain (IPOS for pain ≥2) on day 2. Among those with agitated delirium, 79% continued to exhibit agitation symptoms on day 2.

CONCLUSION

Despite specialized palliative care, the combined distress of cancer pain and delirium in the last days of life remains complex and refractory.