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Observational Study
. 2025 Feb;14(3):e70677.
doi: 10.1002/cam4.70677.

Pharmacological Strategies for Providing Patients With Delirium Relief From Terminal Dyspnea: A Secondary Data Analysis

Takaaki Hasegawa  1 , Masanori Mori  2 , Takashi Yamaguchi  3 , Kengo Imai  4 , Yoshinobu Matsuda  5 , Isseki Maeda  6 , Yutaka Hatano  7 , Naosuke Yokomichi  2 , Jun Hamano  8 , Tatsuya Morita  2 ; East Asian Collaborative Cross‐Cultural Study to Elucidate the Dying Process (EASED) investigators
Affiliations
Observational Study

Pharmacological Strategies for Providing Patients With Delirium Relief From Terminal Dyspnea: A Secondary Data Analysis

Takaaki Hasegawa et al. Cancer Med. 2025 Feb.

Abstract

Introduction: Systemic opioids are recommended as a pharmacological treatment for dyspnea, and antipsychotics are widely used for delirium. Because little is known about optimal palliative pharmacological strategies for dyspnea in patients with delirium, this study explored the symptom course in such cases, including the use of opioids and antipsychotics.

Methods: This was a secondary analysis of a multicenter prospective and observational study. We consecutively enrolled adult patients with advanced cancer at palliative care units in Japan. The eligibility criteria for their participation were a dyspnea Integrated Palliative care Outcome Scale (IPOS) score ≥ 2 and the presence of delirium. We investigated pharmacological strategies, IPOS for dyspnea, and delirium symptoms using item 9 of the Memorial Delirium Assessment Scale.

Results: Of the 1896 patients, 141 were found eligible and were analyzed. Eighty-two (58%) patients had agitated delirium, and the median survival period was 4 days. Regarding pharmacological strategy, 31 (22%) received opioid initiation or dose escalation, whereas 92 (65%) used regular antipsychotics. Although mean dyspnea IPOS scores significantly decreased from Day 1 to Day 2 (0.44, 95% CI: 0.24-0.64), the proportion of responders (IPOS score ≤ 1) was 21% (30/141). In the agitated delirium group, the proportion of remaining agitation symptoms at Day 2 was 74% (61/82).

Conclusions: The combined distressing symptoms of dyspnea and delirium during the last days of life are likely to be refractory suffering, which shows a poor response to pharmacological interventions, including opioids and antipsychotics.

Keywords: antipsychotic agents; delirium; dyspnea; neoplasm; opioid; palliative care.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart showing the recruitment of participants. PCU, palliative care unit; PPS, palliative performance scale.
FIGURE 2
FIGURE 2
Proportion of patients based on longitudinal changes in dyspnea intensity (IPOS score for dyspnea) at Day 2. Responder means having an IPOS score for dyspnea ≤ 1. Persistence means an IPOS score for dyspnea ≥ 2. “Cannot assess” signifies no available responses owing to an IPOS score for dyspnea at day 2 categorized as “Cannot assess.” IPOS, integrated palliative outcome scale.
FIGURE 3
FIGURE 3
Changes in the mean scores of IPOS for dyspnea. Bars show standard error. IPOS, integrated palliative outcome scale.
See this image and copyright information in PMC

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