Management of altered mental status and delirium in cancer patients

Imad El Majzoub, Hussna Abunafeesa, Rola Cheaito, Mohamad Ali Cheaito, Ahmed F. Elsayem


Delirium is a syndrome characterized by acute onset of changes in awareness and cognition, which fluctuate in severity during the episode. Altered mental status (AMS) and delirium have a high incidence rate among patients with cancer and this increases dramatically towards the end of life. Delirium is multifactorial, as cancer patients have an array of predisposing and precipitating factors: metabolic disturbances, structural lesions, in addition to medications and infection. The complex nature of delirium in cancer patients and the high variability of its presentation make its diagnosis and management challenging and frequently missed. Management of delirium requires identifying and correcting the precipitating cause if feasible. Diagnosis of delirium requires a high index of suspicion, and a systematic assessment to confirm the diagnosis and identify the possible cause. This includes detailed history and comprehensive physical examination together with the use of diagnostic tools, for example: Confusion Assessment Method (CAM) tool. Given the considerable distress cancer patients suffer from, clinicians must assure safety of patients with delirium and safety of the medical team caring for the patient. Family members should be provided with counseling and support.