JAMA Oncol
Lorazepam improves comfort in final days for cancer patients with delirium
Study details: A multicenter, double-blind, randomized trial enrolled 75 patients with advanced cancer and persistent agitated delirium across palliative care units in Taiwan and the U.S. Participants were randomized to receive scheduled IV haloperidol, lorazepam, haloperidol plus lorazepam, or placebo every 4 hours. The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) scores over 24 hours; secondary outcomes included rescue medication use, delirium severity, perceived comfort, and adverse events.
Results: Among 72 palliative care patients, those receiving lorazepam—alone or with haloperidol—had significantly lower RASS scores than those receiving haloperidol alone (mean differences: −2.1, P<0.002 and −2.0, P=0.002). No significant differences were found between haloperidol and placebo or between lorazepam and the combination group. Rescue medication use was lowest with lorazepam (32%) and the combination (37%), and highest with placebo (83%; P=.006). Adverse events and survival rates were similar across all groups.
Clinical impact: Proactive lorazepam-based sedation strategies may offer superior control of refractory agitation in terminally ill patients compared with haloperidol alone, without increasing adverse events, enabling more compassionate, individualized end-of-life care.
Source:
Hui D, et al. (2025, July 31). JAMA Oncol. Proportional Sedation for Persistent Agitated Delirium in Palliative Care: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40742738/