Delirium in the oncology intensive care unit: Risk, recognition, and recovery strategies

Delirium represents a severe neurological complication with exceptionally high prevalence in oncology intensive care units (ICU), affecting up to 88% of terminal cancer patients. This acute brain dysfunction emerges from the convergence of critical illness factors with cancer-specific vulnerabilities, creating unique management challenges. This narrative review synthesizes current evidence on delirium epidemiology, risk factors, diagnostic challenges, management strategies, and long-term cognitive outcomes specific to critically ill cancer patients. Delirium demonstrates a profound prognostic impact, increasing ICU mortality odds tenfold and hospital mortality sixfold. Patients experiencing delirium are nearly four times more likely to have cancer treatment modified or discontinued, directly affecting survival. Risk factors unique to this population include chemotherapy neurotoxicity, central nervous system malignancy, paraneoplastic syndromes, and complex medication regimens. While screening tools show strong performance in general ICU settings, validation in cancer populations remains limited. Evidence strongly supports non-pharmacologic multicomponent interventions over pharmacologic approaches, with early mobilization reducing delirium risk by 47%. Long-term cognitive impairment represents a devastating legacy, creating a double burden when superimposed on chemotherapy-related cognitive dysfunction. Management requires specialized preventive approaches prioritizing brain protection through systematic screening, multicomponent prevention bundles, and integrated palliative care.