For a study, researchers sought to determine the relationship between antipsychotic dosage and survival in terminally sick cancer patients with delirium.

A multicenter prospective observational study was secondarily analyzed. Between September 2015 and May 2016, they enrolled adult advanced cancer patients who acquired delirium and were given antipsychotics at 14 palliative care centers. The Cox regression method was used to compute survival hazard ratios after commencing antipsychotics comparing groups with varied oral chlorpromazine equivalent doses: low: <100 mg, moderate: 100-200 mg, and high: ≥200 mg. In addition, smooth splines were used to calculate the antipsychotic dose-specific mortality risk.

About 422 of the 453 patients enrolled were studied. The median antipsychotic dose was 92.6 mg, divided into three categories: low-dose (N=231), moderate-dose (122), and high-dose (69). All patients had an 11-day median survival. The high-dose group had substantially worse survival than the low-dose group (HR: 1.46, 95% CI: 1.08-1.98). Smooth splines indicated that when the antipsychotic dosage rose, HR climbed constantly. In patients treated with atypical antipsychotics, the high-dose group had substantially lower survival than the low-dose group (HR: 2.86), although survival was not statistically different in patients treated with typical antipsychotics (0.99).

Higher antipsychotic dosages were linked to increased mortality in terminally ill cancer patients with delirium. Antipsychotics should be administered at modest dosages and carefully titrated to reduce the risk of death.

Reference: jpsmjournal.com/article/S0885-3924(22)00473-0/fulltext