Delirium Often Seen in Emergency Cancer Patients

Delirium is fairly common, yet often missed, in advanced cancer patients who visit the emergency department (ED), according to a new study.

Researchers at the University of Texas MD Anderson Cancer Center (MD Anderson; Houston, USA) conducted a prospective, randomized, observational study involving 243 English-speaking patients (19 to 89 years of age) with advanced cancer who presented to the MD Anderson ED. All patients were assessed with the confusion assessment method (CAM) to screen for delirium, and with the memorial delirium assessment scale (MDAS; mild, ≤15; moderate, 16-22; and severe, ≥23) to measure delirium severity. ED physicians were also asked whether their patients were delirious.

The results showed that 22 of the enrolled patients (9%) had CAM-positive delirium, with 18 patients suffering mild delirium and four with moderate delirium; median MDAS score was 14. Demographically, 10% of the 99 patients older than 65 had delirium, compared with 8% of the 144 patients younger than 65. ED doctors failed to diagnose delirium in 41% of the patients with delirium. The study was published on July 25, 2016, in Cancer.

“We found evidence of delirium in one of every 10 patients with advanced cancer who are treated in the emergency department,” said senior author Knox Todd, MD, MPH. “We also identified many psychoactive medications that could have contributed to delirium, and sharing this information with treating oncologists may help them avoid such complications in the next patient they treat.”

Delirium is defined as a serious disruption of mental abilities resulting in confused thinking and reduced awareness of the environment; onset is usually rapid, within hours or a few days. Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, and alcohol or drug withdrawal. Because symptoms of delirium and dementia can be similar, input from a family member or caregiver is often needed to make an accurate diagnosis.

Related Links:
University of Texas MD Anderson Cancer Center