Delirium Goes Undetected in Advanced Cancer Patients

Health In Focus   - G J E 4
  • A new study shows that delirium is frequent among patients with the advanced stage of cancer in the emergency department.
  • This condition is under diagnosed by physicians and is common in older patients as well as in younger patients.
  • The study states that all patients in advanced stage of cancer are at a higher risk of getting delirium.
Delirium is an acute state of confusion that is difficult to diagnose and treat. It is one of the most significant reasons for admission into palliative care and is often noticed among people with terminal diseases.
Delirium Goes Undetected in Advanced Cancer Patients
Delirium Goes Undetected in Advanced Cancer Patients

This common neuro-psychotic condition is often dealt with in palliative care but seldom in an emergency setting. Dr. Knox Todd and colleagues from The University of Texas MD Anderson Cancer Center carried out a study to understand the frequency of delirium in patients with advanced cancer in an emergency setting.

‘Delirium could go undetected in advanced cancer patients.’
The patient selection was random and included patients who could speak English and who visited the emergency. The study sample included people within the age group 19 to 89 years.

There were two assessment methods that were adopted
  • Confusion Assessment Method (CAM)
  • Memorial Delirium Assessment Scale (MDAS)

Delirium in Patients with Advanced Cancer in an Emergency Setting

243 patients were enrolled in the study and they were analyzed for the existence of delirium. The results showed that
  • CAM positive delirium was seen in 22 patients (9 percent). They had an MDAS score of 14.
  • Among CAM positive patients,
    • 82% (18 people) showed mild delirium
    • 18% (4 people) showed moderate MDAS score.
  • Advanced cancer patients older than 65 years of age who had delirium were relatively lower in percentage when compared with advanced cancer patients with delirium younger than 65 years of age.
    • 10% of the 99 advanced cancer patients older than 65 years showed CAM positive delirium.
    • 12% of 144 advanced cancer patients younger than 65 years showed CAM positive delirium.

Detection by Emergency Department Physicians

The study by Dr. Knox Todd and colleagues focuses on the detection of delirium by emergency department physicians. When the emergency department physicians were asked about the existence of delirium among their patients, it was found that-

41% (9 patients) were not detected to have delirium.

When asked about the number of patients with delirium "We found evidence of delirium in one of every ten 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 ten percent is likely to be a low estimate," said Dr. Todd.

The study also provides an insight into how the emergency department could play a key role in disease assessment. Dr. Todd and colleagues "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."

  1. "Delirium Frequency Among Advanced Cancer Patients Presenting to an Emergency Department: A Prospective Randomized Observational Study." Ahmed F. Elsayem, Eduardo Bruera, Alan Valentine, Carla L. Warneke, Sai-Ching J. Yeung, Valda D. Page, Geri L. Wood, Julio Silvestre, Holly Holmes, Patricia A. Brock, and Knox H. Todd. CANCER; Published Online: July 25, 2016 (DOI: 10.1002/cncr.30133).
Source: Medindia

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