Impact of delirium on the short term prognosis of advanced cancer patients

Augusto Caraceni, Oriana Nanni, Marco Maltoni, Laura Piva, Monica Indelli, Ermenegildo Arnoldi, Massimo Monti, Luigi Montanari, Dino Amadori, Franco De Conno, Maria Paola Innocenti, Stefania Derni, Laura Fabbri, Cinzia Martini, Ernesto Zecca, Liliana Groff, Marina Marzola, Attilio Gramazio, Costanza Calia, Giorgio CrucianiAndrea Rossi, Paola Turci

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BACKGROUND. The objective of this study was to evaluate the impact of delirium on the survival of advanced cancer patients also assessed with a validated prognostic score (the palliative prognostic [PAP] score). METHODS. The study population was a prospective multicenter consecutive case series of advanced cancer patients for whom chemotherapy was no longer considered viable and who were referred to palliative care programs. Clinical and biologic prognostic factors included in the PaP score were assessed at study entry. The Confusion Assessment Method criteria were applied to screen patients presenting with delirium. Survival times were measured from time of enrollment and death taken as an outcome. Survival curves were traced with the Kaplan-Meier method and comparison were based on log rank tests. RESULTS. Delirium was found in 109 cases among 393 consecutive patients (27.7%). The diagnosis of delirium was independently associated with male gender, central nervous system metastases, lower performance status, worse clinical prediction of survival, and progestational treatment. The survival curve of patients with delirium was significantly different from the nondelirious patients curve (log rank, 31.6, P <0.0001). The median survival time was 21 days (95% confidence interval [CI], 16-27) for the delirious patients and 39 days (95% CI 33-49) for the others. Multivariate analysis showed that the diagnosis of delirium and PaP score were independently associated with prognosis. CONCLUSIONS. The diagnosis of delirium significantly worsens life expectancy prognosticated with the PaP score. By using the PaP score together with the assessment of cognitive status, physicians can correctly predict patients 30-day survival in greater than 70% of cases. (C) 2000 American Cancer Society.

Original languageEnglish
Pages (from-to)1145-1149
Number of pages5
Issue number5
Publication statusPublished - Sep 1 2000


  • Advanced cancer
  • Delirium
  • Palliative care
  • Prognostic factors
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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    Caraceni, A., Nanni, O., Maltoni, M., Piva, L., Indelli, M., Arnoldi, E., Monti, M., Montanari, L., Amadori, D., De Conno, F., Innocenti, M. P., Derni, S., Fabbri, L., Martini, C., Zecca, E., Groff, L., Marzola, M., Gramazio, A., Calia, C., ... Turci, P. (2000). Impact of delirium on the short term prognosis of advanced cancer patients. Cancer, 89(5), 1145-1149.<1145::AID-CNCR24>3.0.CO;2-X