Delirium Observation Screening scale: its use in cancer patients after opioid change

Aim
Delirium is a common complication in the palliative phase of cancer patients and is often related to opioid use. Patients with a risk of developing a delirium at the Palliative Care Unit of our cancer center are monitored for 72 hrs using the Delirium Observation Screening (DOS) scale. In case of a DOS-score 3, a diagnosis is established by a physician. We earlier assessed a change in opioids (shift or increase in dose) as a risk factor for the development of delirium and thus as an indication for monitoring. However, the DOS has never been evaluated for its use in cancer patients after a change in opioids.

L. van Zuylen, H. van Veluw, M. Bannink, P.J. Lieverse, W. Taal, C.C.D. van der Rijt

Method
Records of the patients admitted between February 2004 and March 2006 were studied for risk moments after a change in opioids. The number of patients with an established diagnosis of delirium within 4 days after the start of the DOS were assessed for DOS scores < 3 and 3, respectively.

Results
The DOS was used for 353 risk moments after a change in opioids. The DOS-score remained < 3 in 309 cases. In this group, a delirium was found in 8 patients. In 39 cases, a DOS-score 3 was found. In 17 of them the diagnosis delirium was established. Five DOS records after opioids change were missing.

Conclusion
These results suggest a high sensibility and a rather low sensitivity of the DOS in cancer patients after opioid change with the standard cut off point at 3. Further research is needed to establish the optimal cut-off point for the use of the DOS in these patients.