ADVANCED CANCER PATIENTS OFTEN HAVE DELIRIUM

NEW YORK (Reuters Health) - About 1 in 11 advanced cancer patients presenting to the emergency department has delirium, researchers report.

"Given the devastating consequences of delirium, emergency physicians should have a high index of suspicion to diagnose delirium in advanced cancer patients, and they should recognize the early management of this condition," Dr. Ahmed F. Elsayem from The University of Texas MD Anderson Cancer Center, Houston, Texas told Reuters Health by email.

Delirium is the most common neuropsychiatric syndrome in patients with advanced cancer, but its exact frequency is unknown - although more than 80% of patients with terminal cancer develop delirium in the last days of life.

Dr. Elsayem and colleagues investigated the frequency of delirium among patients with advanced cancer presenting to their emergency department (ED).

Based on the widely used Confusion Assessment Method (CAM), 22 of 243 advanced cancer patients (9.1%) were deemed to have delirium

ED physicians diagnosed 15 study participants with delirium, including 13 of the 22 diagnosed by CAM, but they failed to detect delirium in nine patients (41% of those diagnosed with delirium).

The incidence of delirium did not differ significantly between patients older and younger than 65 years, according to the July 25 Cancer online report.

"This suggests that in the setting of advanced cancer, all patients should be considered, in some sense, 'old adults' at higher risk for delirium," Dr. Elsayem said.

Most of the patients with delirium (82%) had the hypoactive subtype. The rest (18%) had mixed delirium.

In almost all cases, the cause of delirium was multifactorial, with medications playing a contributing role in at least 20 participants.

"Our findings are likely an underestimation of the rate of delirium in patients with advanced cancer in the ED because we excluded some patients more vulnerable to delirium," the researchers say.

"It is understandable to miss delirium in a busy ED," Dr. Elsayem said. "There is a need to develop a short, sensitive and reliable delirium screening tool in EDs."

"Delirium studies in ED are challenging, particularly regarding obtaining consents and other logistics, and this might explain the paucity of studies in this important field," he added. "Ethical boards should ease restrictions on these studies for better understanding of this condition and its management."

SOURCE: http://bit.ly/2a8pzYJ