Early Recognition and Optimal Treatment of Delirium in Patients With Advanced Cancer
3 other identifiers
interventional
101
1 country
2
Brief Summary
The investigators designed a randomised multicenter clinical trial for patients with advanced cancer who are admitted to the medical oncology ward or high-care hospice. On admission all patients with advanced cancer will be asked to participate in this study. Consenting patients will be submitted to delirium observation screening according to the DOS. Subsequently DOS screening will be performed twice weekly until discharge. Each patient who's score is \> 3 (DOS positive) is showing significant symptoms of delirium and will be submitted to the revised Delirium Rating Scale (DRS-R-98) to confirm diagnosis. To test validity of the DOS scale for this particular population, each DOS positive score will be randomly matched with a patient with a DOS score \< 3 (DOSnegative) and this patient will also be submitted to DRS-R-98. When diagnosis of delirium is confirmed by DRS-98, patients will be randomised between treatment of delirium with olanzapine or haloperidol (usual care). Treatment in both groups will consist of identification and management of underlying aetiologies of delirium if possible and adding neuroleptic medication for symptom control. Patients who recover from their delirium episode as well as their caregivers will be asked to complete the Delirium Experience Questionnaire (DEQ) to assess recall of the delirium experience and the degree of distress related to the delirium episode.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for not_applicable
Started Mar 2010
Longer than P75 for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
Study Start
First participant enrolled
March 1, 2010
CompletedFirst Submitted
Initial submission to the registry
February 21, 2012
CompletedFirst Posted
Study publicly available on registry
February 27, 2012
CompletedPrimary Completion
Last participant's last visit for primary outcome
April 1, 2017
CompletedStudy Completion
Last participant's last visit for all outcomes
April 1, 2017
CompletedApril 7, 2017
April 1, 2017
7.1 years
February 21, 2012
April 6, 2017
Conditions
Outcome Measures
Primary Outcomes (1)
DRS-R-98 severity rating score
Primary endpoint for this trial is a DRS-R-98 severity rating score \<15,25, as this is a measure for establishing clearance of delirium.
Until clearance of the delirium signs or for a maximum of 2 weeks
Secondary Outcomes (1)
Delirium resolution rate
Until clearance of the delirium signs or for a maximum of 2 weeks
Study Arms (2)
Olanzapine
EXPERIMENTALHaloperidol
ACTIVE COMPARATORInterventions
After randomisation to olanzapine treatment, olanzapine will be started at an initial dose of 2,5 - 5 mg orally or intramuscularly, after 2 hours subsequent titration of dosage will be based on clinical judgement with a maximum of 20 mg per 24 hours divided over a maximum of 3 gifts. Sustenance dose will consist of half of the total titrated dose per 24 hours in one gift.
After randomisation to haloperidol treatment, haloperidol dosing will be titrated, with repeated dosing of 0,5 - 2mg orally or subcutaneously every 40 minutes until signs of delirium diminish, with a maximum of 20 mg orally or 10 mg subcutaneously per 24 hours. Sustenance dose will consist of half of the total titrated dose per 24 hours in one or two gifts.
Eligibility Criteria
You may qualify if:
- Patient has been diagnosed with advanced cancer
- Age ≥ 18
- Patient or his / her significant other speaks Dutch fluently
You may not qualify if:
- Delirium is due to alcohol withdrawal
- Patient has been diagnosed with glaucoma, Parkinson's disease or dementia
- Patient is being treated with other neuroleptic medication or lithium
- Patient has another psychiatric disorder that is considered (by investigator) to interfere with assessment of delirium
- Patient had a QTc-interval of \> 480 msec on ECG made on admission to the medical oncology ward (ECG is not required if patient is admitted to a high-care hospice)
- Patient has a history of neuroleptic malignant syndrome
- Patient has a history of convulsions.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
VU University Medical Center
Amsterdam, 1081HV, Netherlands
Spaarne Hospital
Hoofddorp, Netherlands
Related Publications (2)
van der Vorst MJDL, Neefjes ECW, Boddaert MSA, Verdegaal BATT, Beeker A, Teunissen SCC, Beekman ATF, Wilschut JA, Berkhof J, Zuurmond WWA, Verheul HMW. Olanzapine Versus Haloperidol for Treatment of Delirium in Patients with Advanced Cancer: A Phase III Randomized Clinical Trial. Oncologist. 2020 Mar;25(3):e570-e577. doi: 10.1634/theoncologist.2019-0470. Epub 2019 Dec 8.
PMID: 32162816DERIVEDNeefjes ECW, van der Vorst MJDL, Boddaert MSA, Verdegaal BATT, Beeker A, Teunissen SCC, Beekman ATF, Zuurmond WWA, Berkhof J, Verheul HMW. Accuracy of the Delirium Observational Screening Scale (DOS) as a screening tool for delirium in patients with advanced cancer. BMC Cancer. 2019 Feb 19;19(1):160. doi: 10.1186/s12885-019-5351-8.
PMID: 30782151DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Henk MW Verheul, MD, PhD
Amsterdam UMC, location VUmc
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- INVESTIGATOR
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Prof. dr.
Study Record Dates
First Submitted
February 21, 2012
First Posted
February 27, 2012
Study Start
March 1, 2010
Primary Completion
April 1, 2017
Study Completion
April 1, 2017
Last Updated
April 7, 2017
Record last verified: 2017-04