Delirium is a condition characterized by confusion, disorientation, and a general alteration in mental status. It often affects critically ill patients, and recent studies have linked it to higher mortality rates. When delirium occurs in patients with cancer in the ICU, the situation can be particularly challenging. Patients with cancer may already have a weakened immune system, making them more vulnerable to infections and other complications associated with delirium. In this article, we will explore how delirium can increase mortality risk in critically ill cancer patients and what can be done to prevent, detect, and manage delirium in the intensive care unit.
Delirium is becoming increasingly common in critically ill patients with cancer and can cause a significant risk of ICU and hospital mortality. In a study published in JCO Oncology Practice, researchers found that delirium was associated with higher ICU and hospital mortality, as well as increased length of stay, among critically ill patients with cancer. The study included 915 critically ill patients with active cancer, with an ICU stay of at least 24 hours at the Memorial Sloan Kettering Cancer Center between January and December 2018. The most common malignancies included hematologic and gastrointestinal cancers. The researchers retrospectively analyzed the data and delirium screening was performed twice a day using the Confusion Assessment Method, which incorporates acute fluctuations in mental status, inattention, disorganized thinking and altered levels of consciousness. Results showed that delirium was present in 40.5% of the patients analyzed. Researchers found that delirium was an independent risk factor for higher ICU mortality, hospital mortality and ICU length of stay. Delirium appeared independently associated with age, longer pre-ICU hospital length of stay, mechanical ventilation, central nervous system involvement, higher Mortality Probability Model II score, do not resuscitate on admission, and sepsis diagnosis. The study had some limitations, such as its retrospective and single-center design, which predisposes it to confounders and selection bias, researchers wrote.
Clinicians who care for critically ill patients with cancer should be aware of the frequency of delirium among this patient population and its association with high ICU and hospital mortality and length of stay. They should preferably perform systematic screening for delirium in patients with cancer admitted to the ICU and implement early mitigating interventions to prevent delirium and shorten its duration. The study suggests that systematic screening for delirium and early mitigating interventions are warranted in critically ill patients with cancer. The study also highlighted the need for future research in this area, to better understand the mechanisms underlying delirium in cancer patients and to develop effective interventions to prevent and treat delirium among this population. Since the number of cancer patients admitted to the ICU is increasing worldwide, this study’s findings have significant clinical implications and underscore the need for appropriate resources and multifactorial interventions to address delirium among critically ill cancer patients. Delirium among cancer patients is a significant problem that needs consideration to improve patient outcomes.
In conclusion, delirium is a serious condition that can have fatal consequences for critically ill cancer patients. It’s essential for healthcare professionals to recognize the signs of delirium and take the necessary steps to manage it effectively. With early intervention, the risk of mortality associated with delirium can be significantly reduced. It’s important for patients and their families to be educated about the condition, its symptoms, and the importance of seeking medical attention if they suspect that their loved one may be experiencing delirium. By working together, healthcare professionals and patients can ensure that delirium is managed effectively, ultimately improving outcomes for critically ill cancer patients.
