Incident Delirium in Hospitalized Cancer Patients: Clinical Factors Associated With Mortality and Prolonged Hospitalization

IntroductionDelirium is a common neuropsychiatric syndrome in hospitalized cancer patients that is associated with poor outcomes such as increased mortality and prolonged hospital stays. However, clinical predictors of delirium-related outcomes in acutely hospitalized, non-surgical cancer patients remain underexplored.MethodsThis was a retrospective cohort study of hospitalized cancer patients at a tertiary-care oncology center between May 2024 and August 2024 who developed delirium. Delirium was defined by a positive Confusion Assessment Method (CAM) screen. Patients who were admitted for surgical reasons or had an altered mental status (AMS) present on admission were excluded. Patient demographics and clinical factors associated with their hospital course were abstracted from electronic medical records. Primary outcomes analyzed were in-hospital mortality, delirium duration, and length of stay (LOS).ResultsA total of 126 patients met the inclusion criteria from a screening pool of 219 patients. The median age was 65.5 years (IQR: 58,73) and 65 patients (51.6%) were male. Nearly half (43.7%) had hematologic malignancies. Twenty patients (15.9%) died during hospitalization. Non-survivors had significantly lower albumin (3.0 vs 3.5 g/dL, <i>P</i> < 0.01), platelets (86 vs 190 × 10³/µL, <i>P</i> = 0.031), BMI (23.3 vs 27.1 kg/m², <i>P</i> = 0.046), and higher LDH (515 vs 273 U/L, <i>P</i> = 0.044). They also experienced delirium for longer (median 3 vs 1 days, <i>P</i> = 0.011), had a higher incidence of sepsis (27% vs 14%, <i>P</i> = 0.015), and received more benzodiazepines before delirium onset (0.152 vs 0.045 mg/day, <i>P</i> = 0.040). Prolonged delirium (>1 day) was associated with similar factors. LOS positively correlated with delirium duration and sedative exposure, and inversely with hemoglobin and platelet counts.ConclusionsDelirium in hospitalized cancer patients may reflect underlying physiological frailty that increases susceptibility to mortality from metabolic derangements, malnutrition, sepsis, and sedative exposure. Early identification of these high-risk clinical factors in cancer inpatients with delirium may help mitigate risks posed by these abnormalities.