Delirium is a confused mental state that can occur in patients who have cancer, especially advanced cancer. Patients with delirium have problems with the following:
There are three types of delirium:
The symptoms of delirium usually occur suddenly. They often occur within hours or days and may come and go. Delirium is often temporary and can be treated. However, in the last 24 to 48 hours of life, delirium may be permanent because of problems like organ failure. Most advanced cancer patients have delirium that occurs in the last hours to days before death.
This summary is about delirium in adults.
There is often more than one cause of delirium in a cancer patient, especially when the cancer is advanced and the patient has many medical conditions. Causes of delirium include the following:
Patients with cancer are likely to have more than one risk factor for delirium. Identifying risk factors early may help prevent delirium or decrease the time it takes to treat it. Risk factors include the following:
The risk increases when the patient has more than one risk factor. Older patients with advanced cancer who are hospitalized often have more than one risk factor for delirium.
Delirium may be dangerous to the patient if his or her judgment is affected. Delirium can cause the patient to behave in unusual ways. Even a quiet or calm patient can have a sudden change in mood or become agitated and need more care.
Delirium can be upsetting to the family and caregivers. When the patient becomes agitated, family members often think the patient is in pain, but this may not be the case. Learning about differences between the symptoms of delirium and pain may help the family and caregivers understand how much pain medicine is needed. Health care providers can help the family and caregivers learn about these differences.Delirium may affect physical health and communication.
Patients with delirium are:
They often need a longer hospital stay than patients without delirium.
The confused mental state of these patients may make them:
This makes it harder for health care providers to assess the patient's symptoms. The family may need to make decisions for the patient.
When the following symptoms occur suddenly, they may be signs of delirium:
Early symptoms of delirium are like symptoms of depression and dementia. Delirium that causes the patient to be inactive may appear to be depression. Delirium and dementia both cause problems with memory, thinking, and judgment. Dementia may be caused by a number of medical conditions, including Alzheimer disease. Differences in the symptoms of delirium and dementia include the following:
Older patients with cancer may have both dementia and delirium. This can make it hard for the doctor to diagnose the problem. If treatment for delirium is given and the symptoms continue, then the diagnosis is more likely dementia. Checking the patient's health and symptoms over time can help diagnose delirium and dementia.Physical exams and other laboratory tests are used to diagnose the causes of delirium.
Doctors will try to find the causes of delirium.
Both the causes and the symptoms of delirium may be treated. Treatment depends on the following:
Treating the causes of delirium usually includes the following:
In a terminally ill patient with delirium, the doctor may treat just the symptoms. The doctor will continue to watch the patient closely during treatment.Treatment without medicines can also help relieve symptoms.
Controlling the patient's surroundings may help with mild symptoms of delirium. The following may help:
Patients who may hurt themselves or others may need to have physical restraints.Treatment may include medicines.
Medicines may be used to treat the symptoms of delirium depending on the patient's condition and heart health. These medicines have serious side effects and the patient will be watched closely by a doctor. These medicines include the following:
When the symptoms of delirium are not relieved with standard treatments and the patient is near death, in pain, or has trouble breathing, other treatment may be needed. Sometimes medicines that will sedate (calm) the patient will be used. The family and the health care team will make this decision together.
The decision to use sedation for delirium may be guided by the following:
Check the list of NCI-supported cancer clinical trials for supportive and palliative care trials about delirium and cognitive/functional effects that are now accepting participants. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug.
General information about clinical trials is also available from the NCI website.
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This PDQ cancer information summary has current information about the causes and treatment of delirium. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Delirium. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/memory/delirium-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389165]
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