Neuropsychiatric Symptoms and Use of Psychotropics in the Last Week of Life in Patients with Advanced Cancer

Abstract

Neuropsychiatric symptoms such as delirium, anxiety, depression, and agitation are prevalent among cancer patients at the end of life, significantly impacting quality of life for both patients and caregivers. Despite their clinical importance, these symptoms are often underrecognised and undertreated. This study aims to assess the frequency of neuropsychiatric symptoms and use of psychotropics in the last week of life in patients with advanced cancer. We conducted a retrospective review of medical records from adult cancer patients who died between January 1, 2024 and September 31, 2024, at Hospice Casa Sperantei and County Emergency Hospital of Brasov, Romania. Data collected included demographic information, documented neuropsychiatric symptoms, and psychotropic prescriptions in the last week of life. Descriptive statistics and subgroup analyses were used to assess symptom prevalence and prescribing trends. Among 305 patients included in the analysis, 70 (23%) had delirium, 55 (18%) had confusion, and 50 (16.4%) had insomnia. The main risk factors for delirium were nausea and constipation. The most used psychotropics in the last week of life were Haloperidol, Midazolam, and Lorazepam, but the patterns of prescribing varied by care setting. These findings highlight the need for improved recognition and management of psychiatric symptoms in palliative care, as well as the development of evidence-based prescribing guidelines to support appropriate and effective psychotropic use in this vulnerable population.