Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. MATERIALS AND METHODS: We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. RESULTS: Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. CONCLUSION: Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.

Seek to “acute palliative care unit with a hospice function”─Activity report of three years palliative care unit opened

<b>【Background】</b>From the time of establishment, management system of palliative care unit of cancer cooperation hospital in this community was created by consultation with regional home care agency. At the time of the current three－year establishment, its role is regarded as “acute palliative care unit with a hospice function”. In addition to the hospice function to perform hospice care for terminal cancer patients, with the aim of palliative care from early stage, it is an emphasis on functionality of acute palliative care unit (1.Symptom relief, 2.Decision support to patients and their families, 3.Adjustment and movement of the location of the medical treatment, 4.Adjustment of the support system at home care is difficult.) as a “second home” in the region for the “community hospice”. <b>【Result】</b>As a result, over three years, hospitalized patient number, home transition number of patients, home transition rate, number of patients dying at home and home mortality were increased, but the average length of stay, readmission rates were reduced. <b>【Conclusion】</b>In OPTIM－study, it is said that the ability to medical and welfare professionals involved in palliative care in the region is "meet" the opportunity, to be able to maximize the ability of the community, our palliative care unit establishment has become the opportunities in this community, cooperation with home care agencies deepened.

A retrospective study of the factors tended to transfer to palliative home care from palliative care unit at a comprehensive cancer center in Japan

<b>Background</b>: The palliative care unit (PCU) at the National Cancer Center Hospital East changed the administrative policy to strengthen the transition to palliative home care. This study aimed to identify the factors tended to transfer to palliative home care in Japan. <b>Methods</b>: We reviewed the medical records of consecutive cancer patients admitted to our PCU during period from October 2010 until September 2011. Patients with performance status 4 and duplication were excluded in this study. We identified variables associated with the discharged group and the others group, using the univariate and multivariate analyses. <b>Results</b>: There were 223 patients (Pts) during periods, 63 Pts (28.3%) discharged to palliative home care and 160 Pts (71.7%) deceased in our PCU. Univariate and multivariate analysis identified: admission from their own home, a good PS of ≤ 2, good oxygen saturation, a good amount of oral intake, maintain of PS at day 15, no dyspnea and no abdominal distention as predictions of a transition to home from our PCU. <b>Conclusion</b>: Our study indicated the factors tended to transfer to palliative home care from PCU in Japan, however this study had some limitations. A prospective study is required to validate these factors.