title: Delirium in patients with head and neck cancer in the outpatient treatment setting.
abstract: OBJECTIVE
  Delirium is a common neurocognitive disorder among patients with cancer. In patients with head and neck cancer, delirium has been examined in the postoperative setting. Because no studies have reported on delirium during outpatient cancer treatment, we conducted a prospective study in 69 patients with head and neck cancer to examine neurocognitive function before, during, and after outpatient treatment. We also conducted a retrospective study in a subset of caregivers. In this paper, we report the prevalence and incidence of delirium and subsyndromal delirium (SSD) during outpatient treatment.
  
  
  METHODS
  Assessments were conducted before treatment, at scheduled treatment visits, and at a 3-month post-treatment visit. Delirium and SSD were assessed using the Confusion Assessment Method (CAM). Following treatment, we retrospectively asked patients (n = 58) and a subset of caregivers (n = 23) whether patients experienced delirium during treatment.
  
  
  RESULTS
  Based on CAM assessments at scheduled treatment visits, six patients (8.6%) developed delirium during treatment. Additionally, 31% of patients and 43.5% of caregivers retrospectively reported delirium. The prevalence and incidence of SSD were 7.2% and 45.3%, respectively.
  
  
  CONCLUSIONS
  These data suggest that delirium and SSD are frequent in patients with head and neck cancer undergoing outpatient treatment. Delirium was often associated with medical complications. The potential impact of delirium and SSD on treatment outcomes, recovery, and caregiving are significant clinical concerns.
authors.affiliation: Vanderbilt University School of Nursing, 505 Godchaux Hall, 461 21st Avenue South, Nashville, TN 37240, USA. stewart.m.bond@vanderbilt.edu
authors.forename: Stewart M
authors.initials: SM
authors.lastname: Bond
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: John L
authors.initials: JL
authors.lastname: Shuster
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D017028:Caregivers; D003072:Cognition Disorders / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012189:Retrospective Studies