Symptomatic therapies and supportive care issues

Introduction The supportive care of cancer patients routinely involves management of multiple symptoms as well as neuropsychiatric disorders associated with cognitive dysfunction, notably delirium, but also in some instances depression. Cancer therapies themselves (especially medications) can cause or exacerbate cognitive dysfunction. Cognitive disorders of all types are the second most common psychiatric disorders experienced by cancer patients after mood disorders (Derogatis et al., 1983). Patients in particular settings and stages of the disease continuum are at particular risk for cognitive impairment, with potential implications for prognosis. The boundaries between these disorders are not always distinct, which complicates accurate diagnosis and treatment. Co-morbidity is common. The stigma associated with mental illness and the physical burdens of caring for affected patients place family members and other caregivers at increased risk for physical and emotional distress. The common cognitive disorders seen in the oncology setting often respond well to treatment. In other cases, palliation of symptoms is possible and individual patients may respond to creative and unconventional medication interventions. Here we discuss common neuropsychiatric syndromes and clinical settings associated with cognitive dysfunction and altered mental status and behavior, interventions, and potential areas for future research. Delirium The American Psychiatric Association defines delirium as a syndrome characterized by rapid onset of impaired cognition, and altered consciousness, and it is presumed to be due to one or more physical or disease-related factors (Table 18.1, American Psychiatric Association, 2000; DSM-IV TR).