Delirium in advanced cancer

Delirium is a distressing and under-diagnosed syndrome of acute alteration in mental state. It occurs frequently in patients with advanced cancer and is often associated with a worsening of prognosis and difficult challenges in symptom management. Given its associations with older age, recognition and management of delirious patients are likely to become an even more important aspect of oncological practice in the future. The potential for prevention of delirium is being studied, and protocols which involve modifications in hospital care, in addition to screening and rapid identification and treatment of precipitants, may reduce the burden of the condition. However, such approaches require further study and validation in an advanced cancer population. Routine use of appropriate and validated screening tools is a low burden strategy which is likely to improve diagnosis, care and understanding of delirium. The evidence to guide pharmacological management is not strong. Well designed clinical trials are urgently needed in order to improve supportive care outcomes for delirious patients and to clarify the role of antipsychotic and other medications in symptomatic management.