The Effect of Continuous Subcutaneous Infusion of Chlorpromazine on Refractory Delirium in Advanced Cancer: Retrospective Study

• Published in: Palliative Care Research 2019, Vol.14(3), pp.169-175
• Main Authors: Kiuchi, Daisuke, Hisanaga, Takayuki, Hagiwara, Shingo, Abe, Katsuya, Osada, Akira, Higashi, Kenjirou, Sugihara, Yuki, Numata, Aya, Hisahara, Ko, Morita, Tatsuya, Ogawa, Asao, Shima, Yasuo
• Format: Article
• Language: English
• Subjects: chlorpromazine; communication capacity; continuous subcutaneous infusion; delirium; palliative care unit
• ISSN: 1880-5302; 1880-5302
• DOI: 10.2512/jspm.14.169

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p