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Differing management of people with advanced cancer and delirium by four sub-specialties

Sydney South West (western zone) Area Palliative Care Service, Braeside Hospital, Prairiewood, New South Wales; Sacred Heart Palliative Care Services, St Vincents Hospital, Darlinghurst, New South Wales; University of New South Wales, Randwick, New South Wales; Department of Palliative and Supportive Services, Flinders University, Daw Park, Adelaide, South Australia, meera.agar{at}sswahs.nsw.gov.au

DC Currow

Department of Palliative and Supportive Services, Flinders University, Daw Park, Adelaide, South Australia

J Plummer

Pain Management Unit, Flinders Medical Centre, Bedford Park, South Australia

R Chye

Sacred Heart Palliative Care Services, St Vincents Hospital, Darlinghurst, New South Wales

B Draper

University of New South Wales, Randwick, New South Wales; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales

Introduction: Delirium in advanced cancer is prevalent, with limited prospective data to guide management. The aim was to survey current practice of specialists using two contrasting cases of delirium in cancer. Methods: A questionnaire was designed to identify investigations and treatment used, in relation to two cases. Results: Overall response rate (n = 270) was 30%. Place of care: Only 35% of medical oncologists would consider care at home for a patient with reversible delirium compared with 66% of other specialists. Investigations: 85% specialists would order basic bloods, however, medical oncologists were more likely to use oxygen saturation and head computed tomography, psychogeriatricians more likely to order thyroid function and palliative medicine specialists less likely to order chest X-ray and urine culture. Greater than 40% of specialists would do no investigations for terminal delirium. Treatment: Medical oncologists use more pre-emptive therapies and more likely to use a benzodiazepine as agent of choice, and Palliative medicine specialists used significantly more neuroleptics to treat hypoactive symptoms of delirium. Discussion: The survey emphasise significant areas of variability in the management of delirium in advanced cancer. Furthermore, evidence to guide management in ways that draw on the strengths and knowledge of each specialty is urgently needed.

Key Words: advanced cancer • delirium • non-pharmacological management • pharmacological management • reversible delirium • terminal delirium

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