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Chapter 18 - Somnolence

Published online by Cambridge University Press:  24 April 2026

By
Leticia Flores and
Hannah Kissel-Smith
Edited by
Angela Bray Lindsay and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. Delirium is an acute-onset disruption in attention and cognition and is very common in patients with advanced malignancy. It can present as hypoactive, hyperactive, or mixed delirium.

2. Episodes of delirium in malignancy are associated with increased length of hospitalization, healthcare cost, and mortality.

3. Rapid identification of delirium and treatment of potential reversible causes is the mainstay of treatment, and there should be emphasis on non-pharmacological interventions for management.

4. There is no specific recommended workup of delirium, therefore lab and imaging studies should be ordered based on the patient’s clinical presentation and risk factors.

5. Physical restraints and psychotropic medications such as antipsychotics and benzodiazepines should be avoided when able as they are associated with worse outcomes, particularly in older patients.

Keywords

Deliriumaltered mental statusconfusioncognitionbehavioral changedelirium managementantipsychotic medicationhypoactive deliriumhyperactive deliriumagitationoncologic emergency

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 87 - 91
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Bush, SH, Bruera, E. The assessment and management of delirium in cancer patients. The Oncologist. 2009;14(10):1039–1049.CrossRefGoogle ScholarPubMed
Egberts, A, Alan, H, Ziere, G, Mattace-Raso, FUS. Antipsychotics and lorazepam during delirium: are we harming older patients? A real-life data study. Drugs Aging. 2021;38(1):53–62.CrossRefGoogle ScholarPubMed
El Majzoub, I, Abunafeesa, H, Cheaito, R, Cheaito, MA, Elsayem, AF. Management of altered mental status and delirium in cancer patients. Ann Palliat Med. 2019;8(5):728–739.CrossRefGoogle ScholarPubMed
Guo, Y, Mu, Y, Wu, T, Xu, Q, Lin, X. Risk factors for delirium in advanced cancer patients: a systematic review and meta-analysis. Eur J Oncol Nurs. 2023;62:102267.CrossRefGoogle ScholarPubMed
Han, JH, Zimmerman, EE, Cutler, N, Schnelle, J, Morandi, A, Dittus, RS, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med. 2009;16(3):193–200.CrossRefGoogle ScholarPubMed
Lawlor, PG. Cancer patients with delirium in the emergency department: a frequent and distressing problem that calls for better assessment. Cancer. 2016;122(18):2783–2786.CrossRefGoogle ScholarPubMed
Martínez-Arnau, FM, Buigues, C, Pérez-Ros, P. Incidence of delirium in older people with cancer: systematic review and meta-analysis. Eur J Oncol Nurs. 2023;67:102457.CrossRefGoogle ScholarPubMed
Sands, MB, Wee, I, Agar, M, Vardy, JL. The detection of delirium in admitted oncology patients: a scoping review. Eur Geriatr Med. 2022;13(1):33–51.CrossRefGoogle ScholarPubMed

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