Symptom Specific Services

Delirium
• Is concentration, remembering, or memory affected in cancer patients?
• How might delirium affect me?
• How can delirium be managed?

Is concentration, remembering, or memory affected in cancer patients?
Cancer and its treatment may affect the brain, which can complicate the situation and any emotional adjustments you need to make.

Normally, the brain is protected from injuries since the circulation of oxygen and nutrients is done not through the blood, but indirectly through the cerebrospinal fluid, a clear fluid that bathes the brain and spine.

For people with cancer, however, this protection can break down and allow potentially harmful substances into the brain. As a result, brain function in cancer patients may be more sensitive to changes in body chemistry or medications. These changes can manifest themselves as an inability to pay attention to details, absorb and process information, or control emotions.

Many drugs used to treat cancer act directly on the brain, especially hormones and drugs that treat pain, nausea and vomiting. This action on the brain can have a negative effect on other parts of the body. Obvious changes in body function, such as very high or very low blood pressure, extremes in blood sugar (glucose) levels, shortness of breath, or salt imbalances, may require immediate attention.

Subtle side effects are often most noticeable to family members or care partners, rather than members of the health care staff. Any changes in attention span, thinking, memory, or mood should lead to an attempt to find out what factors caused these changes, and how they can be reversed.

Delirium is a malfunction of the brain that can impair your ability to pay attention to events or things said to you in a conversation. Delirium may hinder your memory, especially for events that have occurred recently. People who experience delirium may lapse in and out of consciousness and may have problems with thinking, perception, emotion, memory, muscle control, sleeping and waking. The patient may be disoriented, and symptoms may come and go and may suddenly start or stop.

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How might delirium affect me?
Delirium can cause you to act unpredictably, including becoming physically violent. Even a quiet or calm person can experience a change in mood or become agitated, requiring medical care.

Delirium and dementia can share clinical features such as disorientation, impaired memory, impaired thinking ability, and impaired judgment. Delirium is different from dementia, however. Dementia is characterized by loss of recent memory and impaired thinking, but unlike delirium, it develops over months or years, not hours or days.

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How can delirium be managed?
The causes of delirium must be identified and corrected at the time the symptoms are being treated. Medical professionals may treat the symptoms by providing support to you and your family, making the environment feel safer for the patient, and using appropriate medications. To prevent the patient from harming him or herself, a caregiver may need to be present at all times.

Deciding if, when and how to treat a person with delirium depends on:

• The setting (in the hospital or at home).

• Progression of the cancer.

• The wishes of the patient and family.

• How badly the symptoms are affecting the patient and family's safety.

Simple things should be done first. If you are confined to bed, putting pillows around the bed or using a hospital bed with side rails can keep you from rolling out or getting up without assistance. Also, a bell or an intercom-type monitor can enable you to call for help.

Any reversible cause of delirium should be undone. Reversible causes include adjusting medications, treatment for infections or anemia, and changing foods or fluids. You should not make these changes on your own. Rather, you should ask your doctor or nurse. In some cases, stopping medications suddenly can worsen the exact situation you are trying to fix.

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