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Trajectory of severity of postoperative delirium symptoms and its prospective association with cognitive function in patients with gastric cancer: results from a prospective observational study

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Abstract

Purpose

Delirium is a common neurocognitive complication in cancer. Despite this, the studies examining the trajectory of the severity of delirium symptoms and its impact on health outcome in gastric cancer is rather limited. This study examined the trajectory of delirium symptom severity (DSS) following resection surgery for gastric cancer and its prospective association with cognitive function.

Methods

A three-wave prospective observational study was conducted with 242 gastric cancer patients admitted for resection surgery at a teaching hospital in South Korea from May 2016 to November 2017. DSS was assessed by the clinical staff before and 1, 2, 3, and 7 days after surgery using the Delirium Rating Scale-Revised-98. A survey including the Functional Assessment of Cancer Therapy-Cognitive Scale (FACT-Cog) and Mini-Mental State Examination (MMSE) was administered before surgery (T0), 7 days after (T1), and 3 to 6 months after surgery (T2).

Results

Out of 242 participants, 48.8% (118) completed the survey at all three time points, 43.4% (105) did so for two time points, and 7.9% (19) for one time point. No cases of full delirium were observed over four postoperative time points. Latent growth curve modeling analyses indicated that DSS declined over 3 days after surgery. Age and anesthesia time were positively associated with the initial level of DSS. A medication history for memory complaints was related to a slower recovery from delirium symptoms. While the use of propofol as an anesthetic agent was associated with lower initial DSS, it predicted a slower recovery from DSS. A higher initial DSS predicted a lower T1 MMSE score.

Conclusions

Severity of postoperative delirium symptoms predicts a short-term and objective cognitive function post-surgery. Monitoring and timely treatment of postoperative delirium symptoms is needed to diminish cognitive consequences in gastric cancer patients.

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Funding

This study was supported by a grant of the Korean Mental Health Technology R & D Project, Ministry of Health & Welfare, Republic of Korea (HM15C1224).

Author information

Authors and Affiliations

  1. Department of Psychology, Pusan National University, Busan, South Korea

    Eun-Jung Shim & Hae Lim Noh

  2. Public Health and Medical Service, Seoul National University Hospital, Seoul, South Korea

    Kwang-Min Lee

  3. Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Heesung Hwang & Bong-Jin Hahm

  4. Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang, South Korea

    Kyung-Lak Son

  5. Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea

    Dooyoung Jung

  6. Department of Psychiatry, Inha University Hospital, Incheon, South Korea

    Won-Hyoung Kim

  7. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Seong-Ho Kong, Yun-Suhk Suh, Hyuk-Joon Lee & Han-Kwang Yang

  8. Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea

    Bong-Jin Hahm

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  1. Eun-Jung Shim
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Correspondence to Bong-Jin Hahm.

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Shim, EJ., Noh, H.L., Lee, KM. et al. Trajectory of severity of postoperative delirium symptoms and its prospective association with cognitive function in patients with gastric cancer: results from a prospective observational study. Support Care Cancer 27, 2999–3006 (2019). https://doi.org/10.1007/s00520-018-4604-4

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