Table 2.
Author (endnote reference number) | Cancer primary site (%) | Age in yrs, mean sd (range) mlos (days) | Other correlates of burden of disease | Index delirium tool assessor sensitivity and specificity vs diagnostic standard | Other delirium detection tools | Diagnostic or research reference standard, assessor, assessor training | Delirium rate test reversibility |
---|---|---|---|---|---|---|---|
Oncology setting | |||||||
Gaudreau et al. JPSM [31] | Hematologic 86(33%) Gastrointestinal tract 35(13.4%) Lung 21(17%) Bones/soft tissue 24 (9.2%) Genital 11(4.2%) Urinary 14(5.4%) Breast 16 (6.1%) Ovary 12(4.6%) Colorectal 26(10%) Other 16(6.1) | 59.6 ± 14.3 | 154/261 (59%) loco regional disease only | TOOL: NuDESC ASSESSOR: routine administration by bedside nurses familiar with tool. Sensitivity: 0.857 (0.654–0.950) Specificity: 0.868 (0.727–0.943) | 1. CAM assessed by psychiatrist (73% of patients) 2. MDAS by research nurse 3. MDAS by psychiatrist 4. DSM-IV by research nurse 5. DSM-IV by psychiatrist CAM training not specified | TOOL: CAM; ASSESSOR: research nurse; ASSESSOR TRAINING: research nurses were trained over six 2-h on- site sessions with psychiatrists in the use of the CAM, the MDAS, and the DSM-IV criteria for delirium. Inter-rater reliability: kappa = 0.89 (95% CI, 0.75–1.0) of research nurse—psychiatrist for the CAM | Incidence 16.5% (43/261) on basis of NuDESC REVERSIBILITY: not reported |
Grandahl et al. [40] | Gastrointestinal 30 (37%), Lung 28 (35%), Breast 16 (20%) Other 7 (9%) | 68.5 ± 7.8 (42—86) | not reported | Battery of tests of cognition | CAM training not specified | TOOL: ICD 10 diagnosis ASSESSOR: not stated ASSESSOR TRAINING: not stated | Prevalence 33% (27/81) on basis of DSM IV REVERSIBILITY: not reported |
Ljubisavljevic et al. [3] | Haematological 70 (57%) gastro-oesophageal 23 (19%) breast 11 (9%) melanoma, osteogenic sarcoma, germ cell tumour 4 (3%) each, colon 3 (2%), other 3 (2%) | 53 -SD and range not reported mean LOS 5 | CNS tumour 9% | NA | CAM by psychiatrist for positive cases. Training not specified. Clinical review by consultant psychiatrist for all positive cases and a sample of 10 (consenting) negative cases | TOOL: CAM ASSESSOR: ward nursing staff ASSESSOR TRAINING: weekly sessions prior to and throughout study period CAM completion 80% | Prevalence 18% (26/145 admissions) REVERSIBILITY: not reported |
Neefjes et al. [41] | Gastrointestinal 196 (34%) Genito-urethral 22 (4%) Head and Neck 19 (3%) Breast 9 (2%) Lung < 1 | 60 ± 13.1 MLOS 3 (IQR 2–6) | Included: acute admission (42%) median ECOG 1, alive at discharge 96% 81% "disseminated cancer" 14/81 CNS metastases | TOOL: DOSS or clinical diagnosis, and without rejection of delirium in the notes ASSESSOR: clinical nurses as part of routine care, or clinician diagnosis | NA | NA | Incidence 3.5% all admissions 7.8% (57/730) for un-scheduled admissions on basis of DOSS REVERSIBILITY: not reported |
Sands et al. [42] | Breast 3/18, lung 2/18 prostate 2/18. 6/18 other, unknown 3/18 * | 53 ± 14.3 (30–79)* | 5/19 distant metastases* | Single question in delirium (SQiD), novel tool | CAM administered by medical students training not specified | TOOL: DSM IV criteria ASSESSOR: Psychiatrist, clinical diagnosis ASSESSOR TRAINING: [core professional competence] | Prevalence 27% (5/18) on basis of DSM REVERSIBILITY: not reported |
Older patients with cancer | |||||||
Bellelli et al. [27] | NA | 81.2 ± 7.5* | Charlson comorbidity index 5.3 + 2.1, Katz's ADL 3.8 + 2.3 Comorbid dementia 53 (16.4) | TOOL 4AT ASSESSOR: attending physician | NA | NA | OLDER CANCER Point prevalence 19.2% (62/323) on basis of 4AT REVERSIBILITY: not reported |
Bond et al. Oncology Nursing Forum[32] | Multiple myeloma 13 (17%), Lymphoma 6 (8%), Lung cancer 11 (15%), prostate cancer 11 (15%), breast cancer 8 (11%) Other 27 (36%) | 74.4 ± 7.29 (65–96) Mean LOS 9.8 | APACHE II score 14.9 (moderate illness severity). IADL score of 6.8 | TOOL: NEECHAM ASSESSOR and TRAINING: unable to access primary source referenced | NA | NA | OLDER CANCER Prevalence 57% (43/76) on basis of NEECHAM REVERSIBILITY: 13/43 (30%) |
Hamaker et al. [44] | Leukaemia 12 (4%), Pancreatic 36 (12%), Colon 32 (11%), Oesophageal 26 (9%), Cholangiocarcinoma 23 (8%), Lymphoma 21 (7%), Breast 18 (6%), Lung 18 (65), Prostate 16 (5.5%), Stomach 15 (5%), Bladder 14 (5%) | 74.9 (65.0–96.2) MLOS 8 (1–80) | 48% receiving supportive care only 55% receiving active[antitumour] treatment 95% living independently 43% metastatic disease at inclusion. 77% impaired ADL. Mean Charlson co-morbidity score 1.1. 15% (31/201) Global cognitive impairment | NA | NA | TOOL: CAM ASSESSOR: "nurse" ASSESSOR TRAINING: not stated | OLDER CANCER Prevalence 21.5% (61/283) On basis of CGA incorporating CAM REVERSIBILITY: not reported |
Acute palliative care setting | |||||||
de la Cruz, et al. [22, 46] | Haematological 74(13%), solid tumour 382 (86%) | 56.51 ± 13.85 | 182 (32%) died index admission ECOG > or = to 3 508/556 (91%) | TOOL: MDAS cutoff ASSESSOR: daily routine, palliative care physician | TOOL: DSM IV ASSESSOR: palliative care physician. Number assessed unclear | NA | APCU Point prevalence on admission 71% 229/556 Incidence: 16.9% 94/327 REVERSIBILITY: 26% (68/229) |
Lawlor et al. 2000, March, Arch Int Med [9] | Lung 17 (30.4%), genitourinary 16 (28.6%), breast in 8 (14.3%), gastrointestinal in 7 (12.5%), haematologic in 4 (7.1%), head and neck in 3 (5.3%), and other in 1 (1.8%) | 64.14 ± 10 | distant mets: 86/104 (83%) | TOOLS: MMSE with cutoff (assessor not explicit) | TOOL: MDAS if DSM positive |
TOOL: DSM IV (not applied to all participants) ASSESSOR: palliative care physician ASSESSOR TRAINING: not stated |
APCU Point prevalence on admission 42% (44/104) incidence 45% (27/60) on basis of MMSE plus MDAS with cutoff REVERSIBILITY: 46/94 (49%) |
Mori et al. [47] | Gastrointestinal 47 (28%) Lung 33 (20%) Breast 10 (6%) Haematological 11 (7%) Gynaecological 10 (6%) Head and Neck 9 (5%) Urological 23 (14%) Other 23 (14%) | 59 ± 13 (Patients who died) 61.3 ± 14.4 (patients alive at discharge) MLOS 8 days (4–12) | metastases 89% | TOOL: MDAS ASSESSOR: daily routine, palliative care physician or clinical judgment of palliative care physicians, advanced practice nurses, or palliative care clinic nurses | NA | APCU Prevalence 73/166 43% on basis of MDAS cutoff REVERSIBILITY: not reported | |
Shin et al. [48] | Haematological 58 (10%) Gastrointestinal 129 (22%) Respiratory 149 (25%) Breast 42 (7%) Genitourinary/gynaecological 85 (14%) Head and Neck 41 (7%) Others 96 (16%) | 58.9 (95% CI 57.8–60.0) MLOS (in APCU) 8.0 (7.6–8.4) | TOOL MDAS or clinical diagnosis ASSESSOR: daily routine, palliative care physician PURPOSE: to determine influence of symptoms on survival | NA | APCU Period prevalence: 48% (284/610) on basis of MDAS cutoff REVERSIBILITY: not reported |
MLOS median length of stay *Unpublished data, ECOG Eastern Co-operative Oncology Group performance status, CAM Confusion Assessment Method, MDAS Memorial Delirium Assessment Scale, MMSE Mini-mental state exam, DSMIV Diagnostic and Statistics Manual 4th edition, ICD-10 International Classification of diseases 10th version, *for cancer patient subset personal communication, 4AT: 4 A's delirium assessment test, NEECHAM Neeson and Champagne confusion Confusion Scale, CAM Confusion Assessment Method, APACHE II Acute Physiology and Chronic Health Evaluation II Score, ECOG Eastern collaborative oncology group performance status, ADL Activity of Daily Living, CGA Comprehensive Gerriatric Assessment, MMSE mini-mental state exam, MDAS Memorial Delirium Assessment Scale, ESAS Edmonton Symptom Assessment Score, APCU Acute Palliative Care Unit