Although delirium is known to negatively affect critically ill patients, little data exist on delirium in critically ill patients with cancer.

We analyzed 915 critically ill patients with cancer between January and December 2018. Delirium screening was performed using the Confusion Assessment Method for the intensive care unit (ICU), performed twice daily. Confusion Assessment Method-ICU incorporates four features of delirium: acute fluctuations in mental status, inattention, disorganized thinking, and altered levels of consciousness. Multivariable analysis controlling for admitting service, pre-ICU hospital length of stay (LOS), metastatic disease, CNS involvement, Mortality Probability Model II score on ICU admission, mechanical ventilation, and others was performed to determine precipitating factors for delirium, ICU, and hospital mortality and LOS.

Delirium occurred in 40.5% (n = 317) of patients; 43.8% (n = 401) were female; the median age was 64.9 (interquartile range, 54.6-73.2) years; 70.8% (n = 647) were White, 9.3% (n = 85) were Black, and 8.9% (n = 81) were Asian. The most common cancer types were hematologic (25.7%, n = 244) and gastrointestinal (20.9%, n = 191). Delirium was independently associated with age (OR, 1.01; 95% CI, 1.00 to 1.02; P = .038), longer pre-ICU hospital LOS (OR, 1.04; 95% CI, 1.02 to 1.06; P < .001), not resuscitating on admission (OR, 2.18; 95% CI, 1.07 to 4.44; P = .032), CNS involvement (OR, 2.25; 95% CI, 1.20 to 4.20; P = .011), higher Mortality Probability Model II score (OR, 1.02; 95% CI, 1.01 to 1.02; P < .001), mechanical ventilation (OR, 2.67; 95% CI, 1.84 to 3.87; P < .001), and sepsis diagnosis (OR, 0.65; 95% CI, 0.43 to 0.99; P = .046). Delirium was also independently associated with higher ICU mortality (OR, 10.75; 95% CI, 5.91 to 19.55; P < .001), hospital mortality (OR, 5.84; 95% CI, 4.03 to 8.46; P < .001), and ICU LOS (estimate, 1.67; 95% CI, 1.54 to 1.81; P < .001).

Delirium significantly worsens outcome in critically ill patients with cancer. Delirium screening and management should be integrated into the care of this patient subgroup.

© 2023 by American Society of Clinical Oncology

Supported, in part, by the Core Grant (P30 CA008748) and the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Conception and design: Jing Tao, Sanjay Chawla, Louis P. Voigt

Collection and assembly of data: Jing Tao, Kenneth Seier Carina B. Marasigan-Stone, Justina-Sheila S. Simondac, Analin V. Pascual, Natalie T. Kostelecky, Evangelina SantaTeresa, Stella O. Nwogugu, Jennifer J. Yang, Joseph Schmeltz, Sanjay Chawla, Louis P. Voigt

Data analysis and interpretation: Jing Tao, Kenneth Seier Carina B. Marasigan-Stone, Joseph Schmeltz, Kay See Tan, Sanjay Chawla, Louis P. Voigt

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to or

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Natalie T. Kostelecky

Research Funding: bioMérieux, RevImmune

Travel, Accommodations, Expenses: bioMérieux

Sanjay Chawla

Stock and Other Ownership Interests: Illumina, Pfizer

No other potential conflicts of interest were reported.


DOI: 10.1200/OP.22.00395 JCO Oncology Practice

Published online February 21, 2023.

PMID: 36808995

ASCO Career Center