Feasibility of prophylactic haloperidol to prevent delirium in cancer patients.

Abstract

232 Background: Approximately 2.5 million cancer patients are hospitalized annually and 25-40% of them will suffer from delirium; yet the majority of delirium is not diagnosed or treated. Delirium rates vary by age and reason for hospitalization and can be as high as 70% in hematopoietic stem cell transplant (HSCT) patients post-transplantation. Delirium can have devastating short and long-term complications and research is ongoing to see if it can be prevented. This study aims to: 1) demonstrate the feasibility of using prophylactic haloperidol in HSCT patients; 2) determine the side effects of oral haloperidol in HSCT patients; and 3) explore the hypothesis that prophylactic haloperidol will reduce the rate of delirium following HCST. Methods: All cognitively intact HSCT patients at a large academic institution were approached for study inclusion. Patients with delirium at time of screening or antipsychotic use in the previous 30 days were excluded. All participants received 5 mg oral haloperidol the night prior to transplant and nightly for 2 weeks post-transplant. Participants were seen daily to evaluate for side effects and every other day to evaluate for delirium using the Delirium Rating Scale (DRS-98). Results: Of the 19 patients who enrolled: 5 withdrew; 9 completed the full (2 week) study; and 5 completed a portion of the study. 22% (2 of 9) patients developed delirium (compared to a historical rate of 43% on our unit). Haloperidol was well tolerated with no evidence of major side effects (1 report of mild restlessness and 1 patient had transient evidence of sedation). Conclusions: Oral haloperidol was well tolerated in HSCT patients. While this study was not designed to detect differences in delirium incidence it provides promising evidence that prophylactic haloperidol may decrease delirium post-HSCT.