463P - The use of antipsychotic for managing delirium in patients with cancer

Background

Delirium represents global brain dysfunction caused by an underlying medical condition. In cancer, it is associated with worse outcome. Antipsychotic medications have been widely used, however evidence in cancer populations is still limited with concern of potential adverse effects.

Methods

A comprehensive search was conducted among PubMed, EMBASE, Science Direct, and Scopus. Keywords used in this systematic review were antipsychotic agents, delirium, and neoplasm. Publications were limited to English manuscripts published in the last 15 years. Quality of each studies were assessed with Newcastle-Ottawa Scale (NOS).

Results

This review included 11 studies with a total of 1,896 patients aged 23 to 99. The cancer types varied and included lungs, gastrointestinal, hepatobiliary, urological, breast, head and neck, pancreas, lymphoma, sarcoma, and skin cancers. Some studies involved patients with brain metastasis and central nervous system lesions. These studies covered different cancer stages, including advanced, terminal, and localized. The antipsychotic medications examined in this review were haloperidol, quetiapine, chlorpromazine/levomepromazine, olanzapine, risperidone, trazodone, aripiprazole, and perospirone. Both typical and atypical antipsychotics were found to be similarly effective in managing delirium, but typical antipsychotics were associated with a higher prevalence of extrapyramidal symptoms. Higher antipsychotic doses were linked to increased mortality in cancer patients with delirium. Delirium outcomes were assessed using scales such as the Memorial Delirium Assessment Scale (MDAS), Richmond Agitation-Sedation Scale Palliative version (RASS-PAL), and others. Adverse events included hypotension, hypokinesia, sedation, extrapyramidal symptoms, falls, aspiration pneumonia, and urinary retention. Notably, no deaths were reported as a result of antipsychotic therapy.

Conclusions

Antipsychotic interventions to manage delirium in cancer patients consistently showed positive effects in addressing immediate distress and become a meaningful component of end-of-life support.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.