Patient-controlled analgesia in patients with advanced cancer. Should patients be in control?

Patient-controlled analgesia (PCA) has been incorporated into the management of chronic pain in cancer patients despite limited evidence of safety and efficacy. Potential benefits of PCA include decreased delay in the administration of opioids from the time requested, rapidity and ease of dose titration, and adaptability to the variable analgesic dosing needs, as well as diurnal changes in patients. PCA may be beneficial for the initial titration of opioids but has the potential to either induce or exacerbate delirium in cancer patients. Clinicians need to closely monitor for symptoms of delirium in advanced cancer patients. The following case presentation highlights the complication of delirium in a cancer patient who was prescribed PCA. Patients with advanced cancer are at increased risk for delirium, which is often difficult to predict.