Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Which is more effective, intravenous haloperidol or chlorpromazine, to improve agitation and communication in agitated terminal delirium? (#434)

Megumi Uchida 1 2 , Tatsuya Morita 3 , Tatsuo Akechi 1 2 , Takuya Kawahara 4 , Asao Ogawa 5 , Kazuhiro Yoshiuchi 6 , Satoru Iwase 7
  1. Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Aichi, Japan
  2. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
  3. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, , Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
  4. Department of Investigator-Initiated Clinical Trials Promotion, Clinical research Promotion Center , University of Tokyo Hospital , Tokyo, Japan
  5. Department of Psycho-Oncology Service, National Cancer Center Hospital East, kashiwa, Chiba, Japan
  6. Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyou-ku, Japan
  7. Division of Palliative Medicine, Saitama Medical University Hospital, Irima

Aim：The purpose of this study was to consider whether there was a significant difference in improvement of agitation and communication between intravenous haloperidol and intravenous chlorpromazine in cancer patients with agitated terminal delirium 72 hours after administration.

Method: All terminally ill delirium patients treated in 15 palliative care wards or by 9 consultation teams were enrolled via the web. Richmond Agitation Sedation Scale-Palliative version, Delirium Rating Scale-Revised 98 (DRD-R98), Nursing Delirium Screening Scale items 2-4, Communication Capacity Scale item 4 and Agitation Distress Scale item 2 were evaluated at the start of treatment (T0) and 72 hours later (T1). In addition, we investigated the type and administration route of antipsychotics used in T0, the presence or absence of changes in medication in T1, and the psychotropic drugs used concomitantly in T1. We investigated whether there is an improvement in DRS-R98 agitation item scores and DRS-R98 communication item scores at T1 in agitated cancer patients who received intravenous haloperidol and intravenous chlorpromazine at T0 and whether there was a significant difference between two groups.

Result: Of 818 enrolled, 424 had agitation at T0. Of these, 183 were in the haloperidol group and 68 were in the chlorpromazine group. The benzodiazepine concomitant rate was 52% in the haloperidol group and 54% in the chlorpromazine group. In both groups, improvement in DRS-R98 agitation item scores was observed at T1, but there was no significant difference in improvement between the two groups. Exacerbation in DRS-R98 communication item score in both group was observed at T1, but there was no significant difference in exacerbation between the two groups.

Conclusion: Intravenous haloperidol and chlorpromazine were similarly effective for terminal agitation. The results of this study need to be validated in clinical trials.