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EDs Often Fail to Diagnose Delirium in Advanced Cancer Patients

HOUSTON – Delirium in patients with advanced cancer is fairly common in the emergency department but remains undiagnosed in many cases.

That’s according to an article published online in the journal Cancer.

The research led by The University of Texas MD Anderson Cancer Center suggests that the condition is similarly common among older and younger patients and advises that all patients with advanced cancer be considered at higher risk for delirium.

Background information in the article notes that studies of delirium, the most common neuro-psychiatric syndrome in patients with advanced cancer, tend to focus on the palliative cancer care setting or solely on elderly patients in the ED.

For this study, researchers compiled a random sample of 243 English-speaking advanced cancer patients, ranging in age from 19 to 89 years old, who presented to the ED. The Confusion Assessment Method (CAM) was used to screen for delirium, and the Memorial Delirium Assessment Scale (MDAS) was employed to measure delirium severity with a scale of mild (less than 15), moderate (16-22), and severe (greater than 23).

Results indicate that 9% had CAM-positive delirium and a median MDAS score of 14. Among CAM-positive patients, delirium was mild in 82% and moderate in 18%, according to the MDAS finding.

Interestingly, patients aged 65 years and older were less likely to have CAM-positive delirium, 10%, than those younger than 65 years, 12%. At the same time, emergency physicians failed to detect delirium in 41% of CAM-positive delirious patients, according to the report.

"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," explained study leader Knox Todd, MD, MPH, in an MD Anderson press release. "We also 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."

“Delirium is relatively frequent and is underdiagnosed by physicians in patients with advanced cancer who are visiting the ED. Further research is needed to identify the optimal screening tool for delirium in the ED,” write study authors who also point out that their research is an example of the importance of the ED as a setting for monitoring the quality of cancer-related care and its potential role in preventing complications of cancer treatment.