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Editor's Correspondence
October 9, 2000

Delirium as a Predictor of Survival in Older Patients With Advanced Cancer

Arch Intern Med. 2000;160(18):2866-2868. doi:

In a recent article, Lawlor et al1 reported a prospective study of delirium in patients with advanced cancer who were referred to an acute palliative care unit. They found terminal delirium in 46 of 52 patients who died in the hospital and poorer survival rates for delirium patients compared with controls.

We studied the occurrence of delirium in a sample of 60 older terminally ill patients admitted to the Hospice Care Unit of the Ancelle della Carità Hospital, Cremona, Italy. The overall mean ± SD age was 73.6 ± 8.3 years, and 28 (47%) were women. On admission, the mean ± SD number of symptoms was 6.2 ± 2.0, the most common symptoms being anorexia (88%), pain (64%), depression (56%), and urinary incontinence (54%). The mean ± SD Karnofsky index score at admission was 36.9 ± 12.9. Patients were assessed using the Mini-Mental State Examination within 2 days of admission, and the diagnosis of cognitive impairment was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.2 In this sample, 17 patients (28%) had delirium, and dementia was observed in 29 patients (48%).