Delirium Frequent and Underdiagnosed Among Advanced Cancer Patients Presenting to an Emergency Department
A new study indicates that delirium is relatively frequent and underdiagnosed by physicians in patients with advanced cancer visiting the emergency department. Delirium was similarly common among older and younger patients, which suggests that in the setting of advanced cancer, all patients should be considered at higher risk for delirium. These findings were published by Elsayem et al in Cancer.
Delirium is the most common neuropsychiatric syndrome in patients with advanced cancer, but most delirium studies in cancer patients have been limited to the palliative care setting, while those in the emergency department setting have been limited to elderly patients. To investigate the frequency of delirium among patients with cancer presenting to the emergency department, a team led by Knox Todd, MD, MPH, of The University of Texas MD Anderson Cancer Center, assessed a random sample of English-speaking advanced cancer patients who presented to the emergency department. All patients were assessed with two methods: the Confusion Assessment Method (CAM) to screen for delirium and the Memorial Delirium Assessment Scale (MDAS) to measure delirium severity (≤ 15 = mild, 16–22 = moderate, and ≥ 23 = severe).
Study Findings
Of 243 enrolled patients with an age range of 19 to 89 years, 22 (9%) had CAM-positive delirium and a median MDAS score of 14. Among CAM-positive patients, delirium was mild in 18 (82%) and moderate in 4 (18%) according to the MDAS.
Of 99 patients aged 65 years and older, 10 (10%) had CAM-positive delirium, compared with 12 (8%) of 144 patients younger than 65 years. When emergency department physicians were asked whether their patients were delirious, they failed to detect delirium in 9 (41%) of the 22 CAM-positive delirious patients.
“We found evidence of delirium in one of every 10 patients with advanced cancer who are treated in the emergency department. Given that we could only study patients who were able to give consent to enter our study, even 10% is likely to be a low estimate,” said Dr. Todd. “We also identified many psychoactive medications that could have contributed to delirium, and sharing this information with treating oncologists may help them avoid such complications in the next patient they treat.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
