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Improving Palliative Care for Cancer
development of and agreement on standardized assessment for delirium;
prevalence, nature, and current treatment for delirium and cognitive impairment;
clinical trials of drugs now used empirically for delirium (haloperidol) and cognitive impairment (methylphenidate);
clinical trials of stimulants to treat cognitive impairment; and
clinical trials of anticancer treatments that include neuropsychological assessments as a required measure of treatment toxicity to determine which treatments may cause cognitive impairment.
Review of Current Funding: CRISP Listings
Searching the CRISP database of current federal funding using the terms cancer and delirium or cognitive impairment produced seven hits. Two relate to basic or clinical research that might have relevance to clinical cancer-related delirium or cognitive impairment. Of these studies, one is descriptive, and one is a basic science study. There are no intervention trials.
CURRENTLY FUNDED CLINICAL TRIALS There are no current trials for delirium or cognitive impairment.
Between one-fifth and three-quarters of patients with advanced disease experience dyspnea, which is moderate to severe in 10 to 60 percent of these patients (Ripamonti, 1999). Not surprisingly, a greater proportion of newly diagnosed lung cancer patients—70 percent—experience dyspnea (Muers et al., 1993). Dyspnea often occurs in the presence of other symptoms: patients with dyspnea were 39 percent more likely to complain of other symptoms and 55 percent more likely to report other symptoms as being severe (Farncombe, 1997). The frequency and severity of dyspnea increase with the progression of the disease and when death is approaching.
Dyspnea may be related to anticancer treatments, including chemotherapy, radiotherapy, and surgery (Komurcu et al., 2000). Treatment of the underlying cancer or treatment of the underlying pulmonary or cardiac disease may relieve dyspnea. Additionally, radiotherapy and chemotherapy may relieve dyspnea even when there is no tumor response. The most common treatments administered to dyspneic patients in the emergency department at the University of Texas M.D. Anderson Cancer Center in the early 1990s were oxygen (31 percent), beta 2-agonists (14 percent), antibiotics (12 percent), and opioids (11 percent) (Escalante et al., 1996).