Treatment of Delirium and Confusional States in Oncology and Palliative Care Settings

Abstract

Delirium is one of the most common neuropsychiatric complications seen in cancer patients, associated with significant morbidity and mortality. Delirium is frequently under recognized, misdiagnosed, and undertreated among cancer patients and in palliative care settings. Psycho-oncologists should be familiar with early recognition, accurate assessment, and proper management of delirium to prevent adverse outcomes of delirium. There have been a growing number of studies in management and prevention of delirium published over the last decade. Antipsychotics, cholinesterase inhibitors, melatonin, and alpha-2 agonists are the pharmacological management options studied in randomized controlled trials in a variety of patient populations, not all in cancer patients or in the terminally ill. In oncology and palliative care settings, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for the control of the symptoms of delirium, with close monitoring for possible side effects especially in older patients and patients with multiple medical comorbidities. This chapter presents an overview of the pharmacological management options for delirium in cancer patients and in palliative care settings.