Occurrence, Causes, and Outcome of Delirium in Patients With Advanced Cancer

Abstract

DELIRIUM IS one of the most common neuropsychiatric complications in patients with advanced cancer.^1-6 The multiple synonyms used to describe this condition, eg, acute confusional state, terminal restlessness, or cognitive impairment, along with the variability in diagnostic criteria have hindered the conduct of research and the comparison of study findings.^7-10 Delirium has been underrecognized and underresearched in general medical patients and patients with cancer.^5,8,10 In patients with advanced cancer, delirium imposes an additional burden of symptom distress, as the consequent awareness and attentional deficits impede communication with their families and hinder participation in treatment decisions, counseling, and symptom assessment.^10-13 Delirium reversibility in advanced cancer has been the subject of much debate^5,6,13,14 but relatively limited research, mainly as retrospective studies^15-18 or case reports^19,20 and in the form of only a few prospective studies.^1,2,21-23 The cause of delirium in advanced cancer is often multifactorial,⁵ but since 1990 there have been increasing literature reports on delirium and other neuropsychiatric side effects of opioids in patients with cancer.^24-26 Previous studies in patients with cancer have not incorporated a standardized or systematic approach to criteria for analysis of precipitating factors similar to that used in the study of elderly hospitalized general medical patients.²⁷