Abordaje terapéutico del delirium en pacientes con cáncer avanzado

In cancer patients some times it is possible to find a relation between delirium episode and drugs, metabolic disturbances, or the cancer itself. In advanced cancer, a multifactorial etiology is most common, but opioids are implicated in more than 60% of the cases. Almost 50% of the episodes of delirium are reversible as it is shown in recent prospective studies. Besides identifying the treatable causes of delirium through a thorough evaluation of the patient, some simple techniques have shown to be effective: change of opioid or lowering its dose, withdrawal of psychoactive medication, and hydration. Good end-of-life care for a patient with delirium is a challenge. The family needs advice and it is important to build a safe and relaxing environment for the patient. Haloperidol is the most frequently used drug for symptom control. New neuroleptics such as risperidone or olanzapine are being tested with good results, but randomized, controlled trials are needed. Methylphenidate has been used for cases of delirium with hypoactivity. This paper is the second part of a previous article about clinical issues and identification of delirium in advanced cancer patients.