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Symptom Management and Supportive Care

The Assessment and Management of Delirium in Cancer Patients

^aDepartment of Palliative Care & Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; ^bMcCulloch House, Southern Health Care Network, Melbourne, Victoria, Australia; ^cFaculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ^dDivision of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada

Key Words. Delirium • Neoplasms • Palliative care • Diagnostic techniques and procedures • Antipsychotic agents

Correspondence: Shirley Bush, M.B.B.S., M.R.C.G.P., Division of Palliative Care, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada. Telephone: 613-562-6262; Fax: 613-562-6371; e-mail: sbush{at}bruyere.org

Received June 18, 2009; accepted for publication September 14, 2009; first published online in THE ONCOLOGIST Express on October 6, 2009.

Disclosures

Shirley H. Bush: None; Eduardo Bruera: None.

Section editor Russell Portenoy has disclosed no financial relationships relevant to the content of this article.

The paper discusses s.c. administration of the parenteral preparation of olanzapine.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Delirium remains the most common and distressing neuropsychiatric complication in patients with advanced cancer. Delirium causes significant distress to patients and their families, and continues to be underdiagnosed and undertreated. The most frequent, consistent, and, at the same time, reversible etiology is drug-induced delirium resulting from opioids and other psychoactive medications. The objective of this narrative review is to outline the causes of delirium in advanced cancer, especially drug-induced delirium, and the diagnosis and management of opioid-induced neurotoxicity. The early symptoms and signs of delirium and the use of delirium-specific assessment tools for routine delirium screening and monitoring in clinical practice are summarized. Finally, management options are reviewed, including pharmacological symptomatic management and also the provision of counseling support to both patients and their families to minimize distress.