Clin Transl Oncol. 2026 Aug 3. doi: 10.1007/s12094-026-04530-2. Online ahead of print.
ABSTRACT
CONTEXT: Delirium is a frequent neuropsychiatric syndrome in patients with advanced cancer, particularly in acute palliative care settings, where its prevalence, reversibility, and prognostic implications remain incompletely characterized.
OBJECTIVES: To determine the prevalence of delirium in acute palliative care units (PCUs), identify associated clinical factors, evaluate reversibility, and assess its impact on overall survival (OS) in patients with advanced cancer.
METHODS: A prospective, longitudinal, observational study was conducted in acute PCUs at two tertiary hospitals. Adult patients with advanced cancer were assessed at admission and every 5 ± 2 days. Delirium was diagnosed according to DSM-5 criteria using the Memorial Delirium Assessment Scale (MDAS; cutoff ≥ 7). Univariate analyses were performed to explore associations with clinical variables. Overall survival was analyzed using Kaplan-Meier methods and Cox regression.
RESULTS: Among 355 eligible admissions, delirium occurred in 28% of patients, with 82% identified at admission. The hypoactive subtype was predominant, and reversibility was observed in 16%. Advanced age and poor functional status were significant predisposing factors, while infection, insomnia, fever, dehydration, immobility, and hypoglycemia were associated conditions. Median OS was significantly shorter in patients with delirium (24.5 95%CI 15-43 vs. 52 days, 95%CI 47-63). In unadjusted analyses, delirium was associated with increased mortality (HR = 1.51; 95%CI 1.19-1.92; p < 0.001). However, this association did not remain statistically significant after multivariable adjustment (adjusted HR = 1.28; 95%CI 0.98-1.66; p = 0.068).
CONCLUSIONS: Delirium affected one in four patients admitted to acute PCUs, showed limited reversibility, and was associated with reduced survival. These findings highlight delirium as a frequent and clinically meaningful syndrome and underscore the importance of systematic screening and early, proactive management in acute palliative care.
PMID:42545626 | DOI:10.1007/s12094-026-04530-2
