Delirium, or acute confusional state, is a serious medical condition. Palliative care physicians encounter acute confusional state frequently in their cancer patients with terminal illness (rates ranging from 25% to 85% study dependent). General consultation-liaison psychiatrists encounter delirious patients on a similar frequency within the general hospital population. The clinical presentation of the delirium, in conjunction with the patients’ current oncological diagnosis and prognosis, will influence the specialty involved in the patients care.

A case study of a 62yo man who developed delirium whilst undergoing post-operative palliative chemo-radiotherapy for glioblastoma multiforme in a tertiary referral hospital is presented. It highlights some of the potential differences in treatment focus and modality from the different medical specialties of radiation oncology, medical oncology, psychiatry and palliative medicine. The case caused considerable distress for the patient, his family and clinicians and some ethical issues arose. 

Much work has been published within the Palliative medicine community regarding delirium in end of life care. More advice comes from the Colleges of Psychiatry, while even more medical guidelines for delirium have recently emerged, such as those of the British National Institute for Clinical Excellence (NICE 2011). Therefore a psycho-oncology clinician could easily become overwhelmed. A review of the medication advice is presented.

This author proposes that further cooperation and alliance between the fields of psychiatry and palliative medicine could assist both sets of clinicians working in the field of psycho-oncology. This could improve the outcome for patients, their families and the clinicians involved.