(Cancer Care) Delirium Care in Terminal Cancer Patients: A Comprehensive Guide

• April 6, 2020
• 3 min read

I. What Is Delirium?

Delirium is a common neuropsychiatric complication in terminally ill cancer patients. It may arise from radiation or chemotherapy side effects, cancer by-products, paraneoplastic syndrome, brain metastases, endocrine disorders, infections, electrolyte imbalances, hypoxia, medications, worsening chronic disease, withdrawal symptoms, nutritional deficiencies, coagulopathy, anemia, failure of major organs, or uncontrolled pain — any of which can cause brain dysfunction and resultant confusion. Approximately 65–85% of terminally ill patients develop delirium, and 83% continue to experience it until death.

II. Common Symptoms

• Sleep-wake cycle disruption
• Poor concentration
• Short-term memory impairment
• Day-night reversal
• Emotional instability, anxiety, irritability, depression
• Visual hallucinations, auditory hallucinations, abnormal behavior
• Confusion, incoherent speech, agitation
• Disorientation (loss of awareness of people, events, time, and place)

III. How to Care for a Patient with Delirium

(i) Identify whether the confusion stems from emotional factors (e.g., stress, anxiety, depression) or physical discomfort (e.g., pain, constipation, urinary retention, extreme temperature), and help eliminate the underlying cause.

(ii) Although the patient may experience confusion and unclear consciousness throughout the day, there may be periods of lucidity. Always treat the patient as a person of clear consciousness. When necessary, healthcare staff will assess and prescribe appropriate sedatives or sleep medications.

(iii) Maintain a calm environment with minimal unnecessary noise or disturbance.

(iv) Patient safety:

1. When the patient requests to get out of bed, assess their safety and physical capacity, and assist with walking or wheelchair outings.
2. When the patient shows restlessness or agitation, use gentle, simple words to soothe them; protect them from injury and avoid physical restraints whenever possible.

(v) Provide orientation cues:

1. Ensure appropriate indoor lighting during the day and night; provide sunlight exposure daily when possible.
2. Place a clock and calendar within the patient's sight; gently remind the patient of the time and location as appropriate.
3. Have familiar people at the bedside; bring familiar personal items (e.g., family photos, preferred sleepwear) to the room to reduce anxiety.
4. When the patient is agitated, use sensory stimulation — lighting, aromatherapy, familiar music, television, or radio — to evoke positive memories, regulate mood, help the patient achieve relaxation and comfort, facilitate acceptance of loss and grief, reduce depression, and promote calmness.

(vi) When the patient shows restlessness or agitation, use simple words to tell them the current date and time (year, month, day, hour), and say: "I am [name]. I will be by your side throughout." Comfort the patient and protect them from injury.

(vii) Family presence, love, and care are more important than any medication. In the final stage of life, only the sincere companionship, love, and care of loved ones can give a terminally ill patient the courage to face each remaining day.

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