Delirium is a common problem for people with cancer, especially those with advanced cancer or those at the end of life. It occurs in 15% to 30% of patients who are hospitalized for cancer and in up to 85% of those in the final weeks of life. Delirium can be very stressful on the patient and his or her family members. It can also interfere with other symptoms and treatments for the cancer, including the treatment of pain.

It is important to clarify the difference between delirium and dementia, since they can have some of the same symptoms. People with delirium develop it quickly, become agitated, and can go in and out of consciousness over time. Memory problems are usually short-term. Dementia develops more gradually, and effects on memory and consciousness are more permanent.

Types and symptoms

There are three types of delirium: hypoactive, meaning that the person acts sleepy or withdrawn; hyperactive, meaning that a person is agitated and has delusions or hallucinations; and mixed, meaning that a person alternates between these two types. More than two thirds of all delirium is hypoactive or mixed.

Symptoms of delirium can include:

• Depression
  
  
• Delusions or hallucinations
  
  
• Restlessness, anxiety, sleep disturbance, irritability
  
  
• Altered level of consciousness or awareness
  
  
• Shortened attention span
  
  
• Memory problems
  
  
• Disorganized thinking and speech
  
  
• Disorientation
  
  
• Reversing day and night
  
  
• Difficulty writing, drawing, or finding words
  
  
• Personality changes

Diagnosis

To develop a treatment plan for delirium, doctors may do a physical examination or take some blood tests. They will also do a mental examination, using tests that check motor skills, memory, and attention level.

Causes

Finding the cause of delirium is often important, in case it can be treated or reversed. A direct cause of delirium is often a brain tumor or other cancer that has spread to the brain from somewhere else in the body. Other causes include:

• Medications, such as pain medications and chemotherapy
  
  
• Withdrawal from medication
  
  
• Fluid and mineral (such as calcium or potassium) imbalance
  
  
• Organ failure
  
  
• Infection
  
  
• Other brain disorders
  
  
• Lack of oxygen in the blood

Nutritional problems

People with advanced cancer are often taking many medications, and have more than one condition relating to age or cancer. Delirium can have many causes, and can begin with a slight change in medication or in the patient's medical condition.

Managing delirium

The main goal in managing delirium is keeping each patient comfortable and safe. These tips may help:

• Provide a reassuring environment for the patient, such as a quiet, well-lit room, having familiar people and objects nearby, and adding a visible clock and/or wall calendar to the room.
  
  
• Talk with the doctor or nurse about hallucinations and other behaviors of the patient; a health care professional can provide helpful information on managing these symptoms and the expected course of the patient’s delirium.

In some cases, antipsychotic or other types of medications can help bring a patient out of delirium; however, these drugs can have significant side effects.

Delirium at the end of life

Treating delirium is a delicate issue for the patients, his or her family and friends, and medical professionals. Some feel the hallucinations that come with delirium at the end of life are part of the dying process and should not be treated. For example, a patient who sees dead family members welcoming them to an afterlife can be a great comfort. However, delirium can switch with very little warning from a peaceful, pleasant experience into a frightening one, and in these cases, treatment might be helpful.

Another option is controlled sedation, which is giving drugs that put a patient into a deep sleep. At the end of life, this can make the patient more comfortable, but may also leave family members with a premature sense of loss. Sedation is not intended to speed up death, but to provide comfort to a patient at the end of life. Even with sedation, a patient may experience moments of clarity and be able to talk with family members.

Each decision about managing delirium depends on the individual. It is important for patients and their family members to talk with their doctors and understand all the treatment options available.

More Information

End of Life Care

Making Decisions About Cancer Treatment

Managing Side Effects

Last Updated: September 28, 2009