Are chemotherapy and radiotherapy risk factors for post-operative delirium in elderly cancer patients undergoing elective surgery? Observational study in two tertiary university hospitals

Tuesday, 19 August 2014
Exhibit hall (Dena'ina Center)
Bruno Neuner, MD , Charité – Universitätsmedizin Berlin, Berlin, Germany
Maren Schmidt, MD , Charité – Universitätsmedizin Berlin, Berlin, Germany
Edith Weiss-Gerlach, PhD , Charité – Universitätsmedizin Berlin, Berlin, Germany
Vera von Dossow-Hanfstingl, MD , LMU Munich, Campus Großhadern, Munich, Germany
Claudia Spies, MD , Charité – Universitätsmedizin Berlin, Berlin, Germany
INTRODUCTION:  

Many elderly cancer patients undergo surgery. Age and impaired physical status are risk factors for post-operative delirium (POD), a cognitive disorder with disorientation, hallucinations and disturbance of vigilance. Aim of this study was to evaluate the independent association of pre-operative chemotherapy and radiotherapy on POD in ≥ 65 year old cancer patients.

METHODS:  

Between 02- 2011 and 09-2012 and after ethical committee approval and written informed consent the study was conducted in 2 tertiary university hospitals in Germany. Patients were categorized according to the American Society of Anesthesiologists physical status classification system (ASA PS) score. Post-operatively patients were screened for POD using the Nursing Delirium Screening Scale, Nu-DESC respectively the Confusion Assessment Method for the ICU (CAM-ICU) within 7 days post-operative. Multivariate analysis was by logistic regression analysis.

RESULTS:  Overall 658 patients (mean age 71.8 years, 68.4% males) with prostate cancers (38.8%), ovarian cancers (13.7%), other cancers of the genito-urinary tract (16.0%), upper gastroinstestinal tract (21.1%) and colorectal cancers (10.5%) were included. Preoperatively 77 patients (11.7%) had received chemotherapy and 27 (4.1%) radiotherapy.  Within the first 7 days after operation 61 patients (9.3%) developed POD. In multivariate analysis adjusted for age, gender, ASA PS score and tumor site, study participants after preoperative chemotherapy were at decreased risk for POD, Odds Ratio = 0.23 (95%-confidence interval (0.07 – 0.73)), p = 0.012 while study participants after radiotherapy showed a tendency for increased POD: OR = 3.1 (95%-CI (0.9 – 10.3)), p = 0.07.

CONCLUSIONS:  

Pre-operative chemotherapy in cancer patients is associated with post-operative delirium.