Delirium in Cancer Patients

Delirium refers to a mental state in which a person is disoriented, confused, or otherwise unable to think clearly. Memory may be affected, and the patient suffering from delirium may also have hallucinations, an excess of excitement, a shortened attention span and changes in behavior. It often comes upon a patient suddenly, and the onset of symptoms may ebb and flow over the course of the day. Delirium is usually temporary and can be treated and reversed, except in the last hours of life.

Delirium occurs in around 20% of those hospitalized with many types of cancer, including mesothelioma, and over 75% of cancer patients who are terminally ill. In cancer patients, possible causes of delirium and other cognitive disorders may be organ failure, electrolyte imbalance, low oxygen levels, thyroid problems, infection, and side effects from medication. It may also result as a direct effect of cancer on the human brain, in the case of a brain tumor or other cancer spreading to the brain. Certain factors place patients more at risk for delirium, such as having advanced cancer or more than one disease. Additionally, older age, a previous mental disorder, and taking medications that affect the mind may increase the risk of delirium.

Delirium often affects a patient’s behavior. Sudden personality changes, anxiety and depression, decreased attention and impaired thinking may all be results of delirium. Though similar in its first stages to dementia, patients with delirium often develop their symptoms suddenly, while dementia patients slowly progress in their disease. Delirium patients suffer more from sleeping problems, and are often distinguished by fluctuating levels of consciousness. Unlike dementia, memory problems associated with delirium are usually short-term. Delirium can appear alongside dementia, making it more difficult to diagnose correctly.

Patients can develop three subtypes of delirium: hypoactive, hyperactive and mixed. Hypoactive delirium results in patients who are lethargic and confused. Hyperactive delirium is characterized by an agitated state, delusions and disorientation. Patients can also experience a fluctuation between the symptoms of both hypoactive and hyperactive delirium, known as mixed delirium. The majority of delirium patients experience hypoactive or mixed delirium symptoms.

Delirium may pass without treatment. Patients who are not at risk of self harm may be simply monitored. For those who need treatment, changing the patient’s surroundings may help. Creating a familiar setting, bringing in family members, allowing patients to view clocks or calendars and limiting noise can all be helpful in reducing symptoms of delirium. Likewise, changing medications or giving fluids may assist the patient. In cases where the patient is at risk of harming themselves, physical restraints may be required. For more severe cases, antipsychotic drugs or sedatives may be prescribed.

Delirium may occur at the end of life, sometimes in the last 24-48 hours. It may not be reversible at this point, due to conditions such as organ failure. Some choose not to treat the delirium at this time, allowing the hallucinations as a part of the dying process. Others choose controlled sedation, which can make the patient more comfortable. However, some family members may have difficulty with this choice if they feel that they are losing a loved one prematurely. Decisions regarding the treatment of delirium through antipsychotic drugs and sedatives should be made on a case-by-case basis after consultation between doctors, patients and families.

Related: depression in mesothelioma patients