Sirohiya P, Maurya P, Gupta N, Vig S, Kumar B, Ratre BK, Gupta R, Bhopale S, Pandit A. Delirium in the oncology intensive care unit: Risk, recognition, and recovery strategies. World J Crit Care Med 2026; 15(3): 114792 [DOI: 10.5492/wjccm.114792]
Corresponding Author of This Article
Prashant Sirohiya, MD, Assistant Professor, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Delhi, India. sirohiyaprashant@gmail.com
Research Domain of This Article
Oncology
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review-article
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Sirohiya P, Maurya P, Gupta N, Vig S, Kumar B, Ratre BK, Gupta R, Bhopale S, Pandit A. Delirium in the oncology intensive care unit: Risk, recognition, and recovery strategies. World J Crit Care Med 2026; 15(3): 114792 [DOI: 10.5492/wjccm.114792]
Prashant Sirohiya, Prateek Maurya, Saurabh Vig, Balbir Kumar, Raghav Gupta, Shweta Bhopale, Anuja Pandit, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Nishkarsh Gupta, Brajesh Kumar Ratre, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Co-corresponding authors: Prashant Sirohiya and Prateek Maurya.
Author contributions: Sirohiya P and Maurya P contributed equally to this work as co-corresponding authors; Sirohiya P and Maurya P designed the research study; Gupta N supervised the project; Vig S, Kumar B, and Ratre BK performed the literature review; Gupta R, Bhopale S, and Pandit A analyzed the data; Sirohiya P and Maurya P wrote the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: AI tools such as ChatGPT and Grammarly are only applied for language refinement, expression clarity and minor polishing to improve readability. No part of the manuscript is fully AI-generated, and all content comes from the authors’ original work, analysis and interpretation. AI is not involved in study design, data analysis, result interpretation or conclusion formulation, nor are any images in this manuscript created by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Prashant Sirohiya, MD, Assistant Professor, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Delhi, India. sirohiyaprashant@gmail.com
Received: September 28, 2025 Revised: October 21, 2025 Accepted: January 28, 2026 Published online: September 9, 2026 Processing time: 327 Days and 21.1 Hours
Abstract
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.
Core Tip: Delirium affects up to 88% of critically ill cancer patients, increasing intensive care units (ICU) mortality tenfold and making post-discharge treatment discontinuation four times more likely. This review introduces the “double burden” of ICU delirium superimposed on chemotherapy-related cognitive impairment, creating unique survivorship challenges. Cancer-specific vulnerabilities include chemotherapy neurotoxicity, central nervous system malignancy, and chimeric antigen receptor T-associated neurotoxicity. Evidence favors non-pharmacologic prevention, with early mobilization reducing delirium by 47%. Delirium thus extends beyond transient confusion to a key determinant of cancer survivorship, potentially transforming ICU admission into a treatment-limiting event.
