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Otani H, Yokomichi N, Imai K, Toyota S, Yamauchi T, Miwa S, Yuasa M, Okamoto S, Kogure T, Inoue S, Morita T. A novel objective measure for terminal delirium: Activity scores measured by a sheet-type sensor. J Pain Symptom Manage 2024:S0885-3924(24)00793-0. [PMID: 38810949 DOI: 10.1016/j.jpainsymman.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
CONTEXT Delirium is a significant concern in end-of-life care. Continuous monitoring of agitation levels using objective methods may have advantages over existing measurement scales. OBJECTIVES To examine whether an objective measure of activity scores measured using a sheet-type non-wearable sensor (Nemuri SCAN [NSCAN]) was correlated with agitation levels measured using the modified Richmond Agitation-Sedation Scale (RASS) in terminally ill patients with cancer. METHODS We conducted a single-center, prospective, observational study in a palliative care unit using the NSCAN to measure activity scores and the RASS to assess agitation levels. RASS scores were prospectively measured by ward nurses blinded to the NSCAN variables. A database was created to pair the RASS scores and activity scores at night on the same day. RESULTS During the observation period, 1209 patients were hospitalized, and 3028 pairs of assessments of 971 patients were analyzed. The NSCAN activity scores significantly increased with increasing RASS scores (Jonckheere-Terpstra test, p < 0.001). The mean values of the activity scores for each RASS score were RASS -5, 28.9; RASS -4, 36.4; RASS -3, 41.7; RASS -2, 57.4; RASS -1, 58.8; RASS 0, 62.6; RASS 1, 79.6; RASS 2, 106.5; and RASS 3, 118.7. CONCLUSION The NSCAN activity significantly correlated with modified RASS agitation scores. Real-time NSCAN data on agitation may aid timely interventions for optimal symptom control. To improve outcomes for patients suffering from terminal delirium, more research on monitoring tools is warranted.
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Affiliation(s)
- Hiroyuki Otani
- Department of Palliative and Supportive Care, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume City, Fukuoka 830-8543, Japan; Department of Palliative Care Team and Palliative and Supportive Care, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Mitami-ku, Fukuoka 811-1395, Japan.
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Saori Toyota
- Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO., LTD., 2-14-5 Higashisuna, Koto-ku, Tokyo 136-8670, Japan
| | - Toshihiro Yamauchi
- Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Satoru Miwa
- Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Misuzu Yuasa
- Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Soichiro Okamoto
- Uguisu home clinic, 3-4-17 Nakajima, Naka-ku, Hamamatsu City, Shizuoka Prefecture 430-0856
| | - Takamasa Kogure
- Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO., LTD., 2-14-5 Higashisuna, Koto-ku, Tokyo 136-8670, Japan
| | - Satoshi Inoue
- Clinical Laboratory Department, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu City, Shizuoka 433-8558, Japan; Research Association for Community Health, 3-24-2 Somechidai, Hamana-ku, Hamamatsu city, Shizuoka 434-0046, Japan
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Huang HL, Chen PJ, Mori M, Suh SY, Wu CY, Peng JK, Shih CY, Yao CA, Tsai JS, Chiu TY, Hiratsuka Y, Kim SH, Morita T, Yamaguchi T, Tsuneto S, Hui D, Cheng SY. Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. Oncologist 2024; 29:e553-e560. [PMID: 37758042 PMCID: PMC10994251 DOI: 10.1093/oncolo/oyad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. METHODS This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. RESULTS Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. CONCLUSIONS Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Chien-Yi Wu
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Republic of China
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chih-Yuan Shih
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
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Kurisu K, Inada S, Maeda I, Nobata H, Ogawa A, Iwase S, Uchida M, Akechi T, Amano K, Nakajima N, Morita T, Sumitani M, Yoshiuchi K. Effectiveness of antipsychotics for managing agitated delirium in patients with advanced cancer: a secondary analysis of a multicenter prospective observational study in Japan (Phase-R). Support Care Cancer 2024; 32:147. [PMID: 38326487 PMCID: PMC10850172 DOI: 10.1007/s00520-024-08352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition. METHODS We conducted a secondary analysis of a multicenter prospective observational study in Japan. The analysis included patients with advanced cancer who presented with agitated delirium and received pharmacotherapy. Agitation was defined as a score of the Richmond Agitation-Sedation Scale for palliative care (RASS-PAL) of ≥ 1. The outcome was defined as -2 ≤ RASS-PAL ≤ 0 at 72 h after the initiation of pharmacotherapy. Multiple propensity scores were quantified using a multinomial logistic regression model, and adjusted odds ratios (ORs) were calculated for haloperidol, chlorpromazine, olanzapine, quetiapine, and risperidone. RESULTS The analysis included 271 patients with agitated delirium, and 87 (32%) showed -2 ≤ RASS-PAL ≤ 0 on day 3. The propensity score-adjusted OR of olanzapine was statistically significant (OR, 2.91; 95% confidence interval, 1.12 to 7.80; P = 0.030). CONCLUSIONS The findings suggest that olanzapine may effectively improve delirium agitation in patients with advanced cancer.
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Affiliation(s)
- Ken Kurisu
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Inada
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Psychosomatic Medicine, Saitama Cancer Center, Saitama, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | | | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Osaka, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, Okinawa, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
- Research Association for Community Health, Hamamatsu, Shizuoka, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Yuan C, Ting C, Guo X. Application effect of "six heart" nursing model intervention in combination with comfort nursing in patients with primary liver cancer undergoing radiotherapy. Biotechnol Genet Eng Rev 2023:1-12. [PMID: 36966377 DOI: 10.1080/02648725.2023.2193059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
To investigate the effects of combining a "six heart" nursing model intervention with comfortable nursing in patients suffering from primary liver cancer receiving radiotherapy. Between March 2017 to March 2022, 70 patients having liver cancer who received radiotherapy at our hospital were chosen and separated into observation and control groups employing the random number table technique, and each group consisted of 35 cases. Patients of the observation group received "six heart" nursing model intervention in addition to comfort nursing based on conventional intervention, while the control group's patients received standard nursing intervention during radiotherapy. After the intervention, the observation groups' scores and total scores of physical and emotional burden and the scores of escaping and yielding were significantly lower than those of the control group, with statistically significant differences (P<0.05). Following the intervention, each dimension's scores, total score and of the resilience scale and the scores of general well-being and quality of life of the observation group were significantly greater in comparison to the control group, with statistically significant differences (P<0.05). The observation group's overall nursing satisfaction rate was 100.00%, which showed a statistically significant difference from the control group's 85.71 (P<0.05). "Six heart" nursing model intervention combined with comfortable nursing can help reduce patients' self-perceived burden, improve psychological resilience, improve patients' general well-being and quality of life.
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Affiliation(s)
- Cailing Yuan
- Department of Hematology and Radiotherapy, Qingdao chengyang District People's Hospital, Qingdao, Shandong, China
| | - Chen Ting
- Division of Disease Control and Prevention, Qingdao chengyang District People's Hospital, Qingdao, Shandong, China
| | - Xiaofeng Guo
- Department of Hematology and Radiotherapy, Qingdao chengyang District People's Hospital, Qingdao, Shandong, China
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Imai K, Morita T, Mori M, Kiuchi D, Yokomichi N, Miwa S, Okamoto S, Yamauchi T, Naito AS, Matsuda Y, Maeda I, Sugano K, Ikenaga M, Inoue S, Satomi E. Visualizing How to Use Antipsychotics for Agitated Delirium in the Last Days of Life. J Pain Symptom Manage 2023; 65:479-489. [PMID: 36682673 DOI: 10.1016/j.jpainsymman.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
CONTEXT How physicians use antipsychotics for agitated delirium in the last days of life varies markedly, which could hamper the quality of care. OBJECTIVES To examine adherence to an algorithm-based treatment for terminal agitated delirium, and explore its effectiveness and safety. METHODS A single-center, prospective, observational study was conducted in a 27-bed palliative care unit in Japan. All adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS) of +1 or more were included; the palliative care specialists determined that the etiology was irreversible, the estimated survival was three weeks or less, and the Eastern Cooperative Oncology Group (ECOG) performance status was three or four. Patients were treated with an algorithm to visualize how to use antipsychotics, with the treatment goal defined as no agitation (RASS≤0) or acceptable agitation for patients and families. We provided all patients nonpharmacological management to alleviate the symptoms of delirium and administered antipsychotic medications when the nonpharmacological approach was insufficient. We measured the adherence rate, RASS, Nursing Delirium Screening Scale items 2, 3, 4 (Nu-DESC), and Agitation Distress Scale item 2 (ADS) on days 0, 1, 3, 7, 14, 21, and 24 hours before death. RESULTS A total of 164 patients were enrolled. Adherence rates were 99, 94, and 89%, and treatment goals were achieved in 66, 83, and 93% on days one, three, and seven, respectively. The mean RASS decreased from +1.41 to -0.84 on day three; Nu-DESC decreased from 4.19 to 1.83, and ADS decreased from 1.54 to 0.38. There were seven severe adverse events (Common Terminology Criteria for Adverse Events (CTCAE) of 3), including aspiration (n = 3), apnea (n = 2), tremor (n = 1), and muscle rigidity (n = 1) on day three. CONCLUSION The algorithm-based treatment could be feasible, effective, and safe. Visualizing how palliative care specialists provide pharmacological management could be beneficial for nonspecialist clinicians, and clinical, educational, and research implications warrant further empirical testing.
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Affiliation(s)
- Kengo Imai
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan.
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Satoru Miwa
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | | | - Toshihiro Yamauchi
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care (A.S.N.), Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine (Y.M.), National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Seri-Chuo Hospital, Toyonaka, Japan
| | - Koji Sugano
- Division of Respiratory Medicine (K.S.), Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Ikenaga
- Department of Palliative Medicine (M.I.), Yodogawa Christian Hospital, Osaka, Japan
| | - Satoshi Inoue
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
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Mori M, Morita T, Bruera E, Hui D. Prognostication of the last days of life: Review article. Cancer Res Treat 2022; 54:631-643. [PMID: 35381165 PMCID: PMC9296934 DOI: 10.4143/crt.2021.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/26/2022] [Indexed: 12/01/2022] Open
Abstract
Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.
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