Patients With Advanced Cancer Presenting to Emergency Departments With Delirium Likely to Die Earlier

Key Points

  • The majority of cancer patients with delirium were admitted to the hospital (80%), whereas only 49% of those without delirium were admitted; patients with delirium were also much more likely to be admitted to the ICU.
  • Advanced cancer patients with delirium were also likely to die earlier, surviving for a median time of between 1 and 4 months after their visit to the emergency department, compared with a median survival time of over 10 months for patients without delirium.
  • Although around half of the patients had advanced directives, these did not seem to have any effect on the rates of hospitalization or survival.

According to a new study published by Elsayem et al in The Oncologist, patients with advanced cancer who are diagnosed with delirium when presenting to emergency departments are more likely to be hospitalized and more likely to die earlier than patients without delirium. This shows the importance of accurately diagnosing delirium in patients with advanced cancer, said lead author Ahmed Elsayem, MD, a provider in the MD Anderson Emergency Center and Professor in the Department of Emergency Medicine at The University of Texas MD Anderson Cancer Center, even though delirium can easily be missed in busy emergency departments.

In patients with advanced cancer, delirium can be caused by various different factors. “Advanced cancer itself is a major cause, and other problems such as medications or infection are triggers that can precipitate the full-blown syndrome,” explained Dr. Elsayem. Previous studies have shown that delirium is associated with poor survival in advanced cancer patients being treated in intensive care units (ICUs) or receiving palliative care in hospices, but no one had investigated whether the same was true for those reporting to emergency departments.

“To the best [of] our knowledge this is the first study to show the poor survival of advanced cancer patients in the emergency department setting,” said Dr. Elsayem.

Previous Study

This study follows on from an earlier study conducted by Elsayem and his colleagues (published in Cancer), in which they assessed the frequency of delirium in advanced cancer patients visiting the emergency department at MD Anderson. They tested for delirium using two separate questionnaires, classifying patients as suffering from delirium if at least one of the questionnaires gave a positive result.

Questioning 243 patients in total, they found that 44, or 18%, were suffering with delirium according to at least one of the questionnaires.

Current Study Findings

In the current study, they investigated the proportion of these cancer patients with and without delirium who were subsequently admitted to the hospital or ICU and recorded how long they lived after their visit to the emergency department. They also looked at whether possessing advanced directives influenced the rates of hospitalization and survival.

They discovered that the majority of cancer patients with delirium were admitted to the hospital (80%), whereas only 49% of those without delirium were admitted; patients with delirium were also much more likely to be admitted to the ICU. Advanced cancer patients with delirium were also likely to die earlier, surviving for a median time of between 1 and 4 months after their visit to the emergency department, compared with a median survival time of over 10 months for patients without delirium. Although about half of the patients had advanced directives, these did not seem to have any effect on the rates of hospitalization or survival.

Given the major influence delirium appears to have on survival, as well as the distress it can cause for patients and their family members, Dr. Elsayem explained that prompt diagnosis and management in hospital emergency departments is essential. In many cases, delirium in advanced cancer patients can be resolved by simply stopping or modifying their medication and treating any associated infections. “Treating the triggers if known—such as stopping medications—is the main treatment for an episode of delirium,” said Dr. Elsayem.

He also suggested that further research needs to be done on this topic, including similar studies on delirium in advanced cancer patients in other emergency departments and with larger groups of patients.

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®.


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