Delirium in patients with cancer at the end of life

PURPOSE: Delirium is a common and distressing syndrome seen in patients wit h advanced cancer. Behavioral manifestations of delirium, such as agitation , may result in medical intervention, stress to family caregivers, and inpa tient hospice admission. The purpose of this study was to examine the frequ ency, characteristics, and presumed causes of delirium in patients with adv anced cancer. DESCRIPTION OF STUDY: Records of ail patients with cancer who were admitted to an inpatient hospice facility in 1995 were reviewed retro spectively (N = 210). Patients were classified as delirious based on the cl inical judgment of the admitting physician. RESULTS: Delirium was the third most common reason for admission (20%). Mal e gender (P = .04) and the presence of a primary or metastatic brain tumor (P = .03) were significant risk factors for delirium, while advanced age an d primary or metastatic liver, lung, or hone cancer were nor. Resolution of the agitation, the most disruptive symptom of delirium. occurred in 69% of patients before death or discharge. CLINICAL IMPLICATIONS: Delirium is common in hospice patients with cancer a nd is an important cause of family distress and increased cost of care. The recognition of early clinical signs and predispostng factors should facili tate prompt diagnosis, Appropriate intervention is usually successful in al leviating the most distressing symptoms of delirium.