Given the major influence delirium appears to have on survival, as well as the distress it can cause for patients and their family members, Dr. Elsayem says that prompt diagnosis and management in hospital emergency departments is essential. Especially as, in many cases, delirium in advanced cancer patients can be resolved by simply stopping or modifying their medication and treating any associated infections. “Treating the triggers if known—such as stopping medications—is the main treatment for an episode of delirium,” says Dr. Elsayem.

He also suggests that further research needs to be done on this topic, including conducting similar studies on delirium in advanced cancer patients in other emergency departments and with larger groups of patients.

“This prospective cross-sectional study of patients with advanced cancer provides new information about the identification of delirium in the emergency department,” says Russell Portenoy, executive director of the MJHS Institute for Innovation in Palliative Care, who is a section editor of The Oncologist and was not involved in the study. “The key findings—that delirium is a poor prognostic sign and that many patients who present with delirium lack advance directives—underscore the need for competent assessment to identify delirium and follow this diagnosis with a plan of care informed by the increased risk of mortality. Importantly, presentation with delirium in the emergency department should trigger evaluation of advance directives, which, if lacking, can be obtained or refined if capacity is present or restored by treatment of the delirium.”