The confused oncologic patient: a rational clinical approach

Abstract

Purpose of review The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. Recent findings In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy. Such advances carry with them an emerging pattern of neurotoxicity which, although less well described in the literature, is now an important consideration to the clinical approach to confusion in cancer patients. Summary Confusion is the most common neurologic complication in cancer and is associated with significant morbidity, mortality, and prolonged hospital stays resulting in increased health care costs. Early recognition and treatment of delirium is essential to improve clinical outcomes.

Delirium in adult cancer patients: ESMO Clinical Practice Guidelines

“…Delirium may occur more frequently with antineoplastic agents that cross the blood brain barrier, such as capecitabine, topotecan or ifosfamide [48,106]. Most episodes are idiosyncratic and reverse after withdrawal of the offending medication [107]. Novel cancer immunotherapies may cause confusion: the acute release of inflammatory cytokines is thought to lead to the development of neurological symptoms, which usually resolve when the therapeutic agent is stopped [108].…”

Clinical profile and outcomes of adult oncological patients presented to the emergency department of a tertiary care hospital

“…Nolan et al described metabolic imbalances as a common cause of confusion seen in cancer patients. (21) Of the total study population, three-fourth of the patients were admitted, whereas onefourth were discharged. The final diagnosis of cancer patients who expired during their hospitalisation period was predominantly disease progression, manifested as malignant hypercalcemia, followed by sepsis.…”

Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana

“…'Sambhramo ---pravartate' (Verse 16) 13 Bone metastasis and advanced cancer can act as predisposing risk factors for delirium. 65 Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes.A good example of the emerging theory of 'Cancer pain' (CP) is cancer-induced bone pain (CIBP), which now is understood as a complex pain state with nociceptive but also inflammatory and neuropathic characteristics.…”