Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial.

BACKGROUND: We evaluated whether the DELirium Team Approach (DELTA) program-a systematic management program aimed at screening high-risk groups and preventing delirium-would improve quality of care in patients hospitalized with cancer. METHODS: A retrospective before-after study was conducted during a pre-intervention period (between October 2012 and March 2013) and a post-intervention period (between October 2013 and March 2014) at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation. RESULTS: After program implementation, the incidence of delirium decreased from 7.1 to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42-0.64). The incidence of adverse events, including falls or self-extubation, also decreased, from 3.5 to 2.6% (OR, 0.71; 95% CI, 0.54-0.92). There was a significant decrease in the prescription of benzodiazepines (OR, 0.79; 95% CI, 0.71-0.87), increase in the level of independence in activities of daily living at discharge (OR, 1.94; 95% CI, 1.11-3.38), and decrease in the length of stay (risk ratio 0.90; 95% CI, 0.90-0.90). CONCLUSIONS: The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.

[Evaluation of aprepitant as a prophylactic antiemetic in the Cisplatin split regimen combined with radiation for patients with head and neck cancer].

The cisplatin split regimen has not been sufficiently well investigated to validate the use of aprepitant as a prophylactic antiemetic. This study aimed to retrospectively evaluate the efficacy of repeated administrations of 3-day courses of aprepitant according to the cisplatin split regimen (20mg/m² day, days 1-4, 22-25, 43-46) in combination with radiation. We compared the worst Grade of nausea between 23 patients with head and neck cancer who had been administered with aprepitant (group A: between January 2010 and June 2010) and 34-patients who were not administered with aprepitant (group B: between July 2011 and December 2012). In group A, the median age was 60 years (range, 35-73 years), the male/ female ratio was 18: 5, and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 0 in 20 patients and 1 in 3 patients. In group B, the median age was 62 years (range, 31-71 years), the male/female ratio was 30: 4, and the ECOG PS was 0 in 31 patients and 1 in 3 patients. The worst nausea grade was 0, 1, and 2 in 21, 2, and 0 patients in group A and in 19, 9, and 6 patients in group B, respectively. The proportion of patients who developed nausea was significantly lower in group A than in group B (8% vs 44%, p<0.01). Of 6 patients who experienced Grade 2 nausea, 5 patients were administered with aprepitant during the next course of chemotherapy, and 60% of them had a lower severity of nausea. Thus, aprepitant could be effectively used as a prophylactic antiemetic in the cisplatin split regimen.

[Hyperglycemia due to atypical antipsychotics in cancer patients with delirium].

We investigated hyperglycemia due to atypical antipsychotics in cancer patients with delirium. Using patient records retrospectively, we investigated 189 cancer patients who were diagnosed with delirium between June 2008 and May 2009. One- hundred fifty-four of the 189 patients used atypical antipsychotics for delirium treatment. Three percent(5/154)of them were admitted with over 350 mg/dL blood glucose during their atypical antipsychotics treatment, however, all cases did not relate the adverse reaction of hyperglycemia with the use of antipsychotics. Most cancer patients with delirium used atypical antipsychotics, and the incidence of hyperglycemia was low.

Usefulness of pharmacist-assisted screening and psychiatric referral program for outpatients with cancer undergoing chemotherapy.

OBJECTIVE: Major depressive disorder (MDD) and adjustment disorder (AD) are common psychiatric disorders in cancer patients but are often overlooked in clinical oncology settings. We introduced a clinical screening program utilizing the Distress and Impact Thermometer (DIT) to identify MDD and AD in cancer outpatients receiving chemotherapy. This study assessed the usefulness of the screening program. METHODS: Pharmacists administered the DIT to consecutive patients undergoing chemotherapy at an outpatient clinic. Psychiatric treatment was recommended to all the patients with positive screening results. The proportion of patients referred to the Psychiatric Service during the program period was then compared with that during a usual care period. RESULTS: Of the 520 patients who started chemotherapy during the 6-month program period, 5.0% (26/520) were referred to the Psychiatric Service and 2.7% (15/520) were diagnosed as having MDD or AD. No statistically significant difference in the referral rates was observed between the two periods (2.7 vs 1.0%, p = 0.46). However, the period from the first chemotherapy treatment until the visit to the Psychiatric Service was significantly shorter during the program period than during the period of usual care (12.9±13.2 days vs 55.6±17.6 days, p<0.001). CONCLUSIONS: The proportion of patients referred to the Psychiatric Service for the treatment of MDD or AD during the program period was not different from that during the usual care period. However, the program was useful for introducing psychiatric treatment at an earlier stage. Further modifications to the program to improve the referral rate are necessary.

Efficacy of prophylactic minocycline treatment for skin toxicities induced by erlotinib plus gemcitabine in patients with advanced pancreatic cancer: a retrospective study.

BACKGROUND: Erlotinib has been reported as being associated with a high incidence of skin toxicities such as acneiform rash, paronychia, and xerosis. OBJECTIVE: The aim of this study was to evaluate the efficacy of prophylactic minocycline treatment for the skin toxicities induced by erlotinib as compared with deferred minocycline treatment in patients with pancreatic cancer treated with erlotinib plus gemcitabine. METHODS: A total of 96 patients were studied retrospectively, of whom 44 received prophylactic minocycline between August 2012 and June 2013 and 52 received deferred minocycline treatment between August 2011 and July 2012 at the National Cancer Center Hospital East, Kashiwa, Japan. In the prophylactic minocycline group, 200 mg/day oral minocycline was prophylactically administered during the treatment period. RESULTS: The incidence rate of acneiform rash and xerosis of any grade during the first 6 weeks of treatment was significantly reduced in the prophylactic minocycline group compared with the deferred minocycline treatment group (47.7 vs. 80.8%, p<0.001; 2.3 vs. 19.2%, p=0.01). Multivariate analysis identified prophylactic minocycline as a significant independent factor associated with the incidence of acneiform rash and xerosis of any severity (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06-0.46, p<0.001; OR 0.11, 95% CI 0.01-0.90, p=0.04). CONCLUSION: Prophylactic minocycline appears to be useful for the management of erlotinib-related acneiform rash and xerosis during chemotherapy in patients with advanced pancreatic cancer.