Cancer patients nearing the end of their life exhibit certain subtypes of delirium that researchers have determined to be strong indicators that their death will be coming soon.
In a study published in the Psychosomatic Medicine: Journal of Biobehavioral Medicine, researchers reported how terminally ill patients who have been assessed to have hypoactive or mixed delirium had a higher probability of imminent death, with younger patients experiencing earlier mortality. They believe that the results of their research may be helpful in more accurately predicting survival in patients who are close to the end of their life.
For the study, the researchers examined survival time and delirium subtypes in 322 individuals with terminal cancer who were about to enter palliative care. They defined delirium as being confused or experiencing altered thoughts or awareness resulting from illness, medication or other causes.
All symptoms of delirium were then categorized based on criteria set forth by the DSM-5: hyperactive delirium involved restlessness, loss of control and increased motor activity, while hypoactive delirium entailed reduced awareness and decreased speech and activity. Mixed delirium is assigned to a patient with fluctuating activity levels or normal psychomotor activity.
Around 30 percent of participants were categorized as having delirium. Out of this number, 15 percent manifested hyperactive delirium; 34 percent showed hypoactive delirium; and 51 percent were classified as having mixed delirium.
Comparing survival times across those diagnosed with delirium, the researchers found that survival time once a patient starts receiving palliative care was shorter for those with delirium, resulting in an average of 17 days compared to 28 for those not diagnosed with delirium. However, they noted that the difference was only critical for patients diagnosed as either having hypoactive or mixed delirium, with differences remaining even after results were adjusted for other factors.
For patients assessed as having hyperactive delirium, they exhibited survival rates that were no different from those not diagnosed with delirium.
How do subtypes of delirium affect survival times? The researchers argue that it may have to do with variations in underlying causes and treatment responses. For instance, hyperactive delirium was typically associated with reversible causes, such as side effects from medication, while hypoactive delirium is commonly related to reduced oxygen levels, multi-organ failure and metabolic disturbances.
"Therefore, hypoactive delirium could be associated with higher mortality rate than hyperactive delirium," explained Sung-Wan Kim, one of the authors for the study.
Accurate survival time prediction is important because it helps ensure good clinical decision-making, proper care strategies and the patient and the family having ample time to prepare for the patient's death.
Photo: Rodrigo Basaure | Flickr
