• Bárbara A Vizzacchi, Aldo L A Dettino, BesenBruno A M PBAMPDepartment of Critical Care, Intensive Care Unit, A. C. Camargo Cancer Center, São Paulo, Brazil.Medical ICU, Internal Medicine Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazi, Pedro Caruso, and Antonio P Nassar.
• Rehabilitation and Palliative Care Supervision, A.C. Camargo Cancer Center, São Paulo, Brazil.
• Crit. Care Med. 2024 Jan 1; 52 (1): 102111102-111.

ObjectivesTo assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge.DesignRetrospective cohort study.SettingA 50-bed ICU in a dedicated cancer center.PatientsPatients greater than or equal to 18 years old with a previous proposal of cancer treatment (chemotherapy, target therapy, hormone therapy, immunotherapy, radiotherapy, oncologic surgery, and bone marrow transplantation).InterventionsNone.Measurements And Main ResultsWe considered delirium present if Confusion Assessment Method for the ICU was positive. We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (i.e., mediated by the development of functional dependence after discharge) of delirium on modification of cancer treatment and whether the modification of cancer treatment was associated with mortality at 1 year. We included 1,134 patients, of whom, 189 (16.7%) had delirium. Delirium was associated with the change in cancer treatment (adjusted odds ratio [OR], 3.80; 95% CI, 2.72-5.35). The association between delirium in ICU and change of treatment was both direct and mediated by the development of functional dependence after discharge. The proportion of the total effect of delirium on change of treatment mediated by the development of functional dependence after discharge was 33.0% (95% CI, 21.7-46.0%). Change in treatment was associated with increased mortality at 1 year (adjusted OR, 2.68; 95% CI, 2.01-3.60).ConclusionsPatients who had delirium during ICU stay had a higher rate of modification of cancer treatment after discharge. The effect of delirium on change in cancer treatment was only partially mediated by the development of functional dependence after discharge. Change in cancer treatment was associated with increased 1-year mortality.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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