Interventions for Managing Delirium Symptoms in Terminally Ill Patients with Cancer: A Scoping Review

BACKGROUND: Delirium is a common and distressing complication in terminally ill patients with advanced cancer, often impairing communication and decision-making, and diminishing the quality of the remaining life. Effective symptom management is essential; however, current clinical guidelines offer limited recommendations, and supporting evidence remains insufficient. OBJECTIVES: This scoping review systematically mapped the existing literature on pharmacological and nonpharmacological interventions for delirium symptom management in terminally ill patients with cancer and identified gaps in the evidence base. METHODS: Following the framework proposed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, we conducted a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ichushi-Web of the Japan Medical Abstract Society for studies published up to August 31, 2023. Subsequently, two updated searches were conducted using the same procedure with the first covering studies published between September 1, 2023, and September 30, 2024, and the second covering studies published between October 1, 2024, and September 30, 2025. Eligible studies evaluated interventions for delirium in adults with terminal cancer with a life expectancy of one month or less. Two reviewers independently screened the studies for inclusion. RESULTS: Of the 1640 articles identified, seven met the inclusion criteria including four randomized controlled trials on pharmacologic interventions, one randomized controlled trial on hydration, and two observational studies on opioid switching. All studies targeted terminally ill patients with advanced cancer and assessed the outcomes related to delirium symptom relief. CONCLUSIONS: This review revealed that the literature addressing delirium symptom management in terminally ill patients with cancer is limited and heterogeneous. Further research is warranted to strengthen the evidence base and to inform clinical practice guidelines for the care of this vulnerable population.