Confusion and delirium seemingly ignored.

Hi TofuSquirrel,

Thanks for getting in touch and welcome to the Online Community.  I’m Kate one of the Cancer Information Nurses here on the Macmillan Support Line.

I am sorry to hear about your dad and how unwell he is. Waiting for results to diagnose cancer and waiting for treatment to start are both hugely stressful periods of time. 

The onset of his confusion could be down to a few things.

Steroids taken at higher doses can cause confusion or changes in thinking. So could be linked if the confusion happened at the same time. These are a few other examples.

The liver function

Antibiotics, pain relief medications

urine infection or another infection.

Too much calcium in the blood

Dehydration

Not enough oxygen.

I would advise to sit down with the medical team and explain that the confusion is not normal for your dad and this concerns you along with the ongoing investigations for the lung cancer.

If you feel that you need to voice your concerns, you can get in contact with PALS in the hospital where dad is currently an inpatient.

Due to this stressful time it is important that you and your mother look after yourselves and get support if you need it.

I hope this information is useful. Please don’t hesitate to get back in contact by email, webchat or phone, if you need further information or support.

Best wishes

Kate,

Cancer Information Nurse Specialist 

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or email us. 

Ref KE/FS

Thank you for your reply, my mum and I did manage to speak to the medical team today and we finally have the results from the pleural fluid analysis. Which showed lymphoma, however the Dr today still believes it's lung cancer. Despite the results saying lymphoma and there clearly being enlarged lymph nodes in his chest. He suggested the reason for his confusion and decline into being pretty much unresponsive to anything except touch could be paraneoplastic syndrome. Which he said is more likely with lung cancer and unlikely to be lymphoma, but (as one of those people who does research as a coping mechanism) just a quick bit of investigation suggests to me that actually, paraneoplastic syndrome can present with lymphoma. He's still on the respiratory ward rather than oncology, so maybe as this isn't his speciality he isn't aware... But he did say they were going to start him oh high dose steroids as that is the beginning of the treatment for lymphoma. As they won't be able to diagnose lung until he's strong enough for a biopsy... Is just steroids a normal way to start treatment for lymphoma? And any idea why, after his results coming back showing lymphoma, would the dr not seem to believe that and stick with the thinking that the lungs were the origin. Especially considering he has had and recovered from non-hodgekins lymphoma before, around 20 years ago... 

Thank you again

Dear TofuSquirrel,

Thank you for getting back in touch. My name is Jo and I am one of the Cancer Information Nurse Specialists who works with Kate on the Macmillan Support Line.

It is understandable that you have more questions about your father’s care and treatment. Steroids often do form part of lymphoma treatment, sometimes as a pre-treatment before chemotherapy. The steroids help destroy lymphocytes, which are the white blood cells from which lymphoma develops.

It is difficult to know exactly why his doctors feel that he has a lung cancer rather than a lymphoma, despite the result from the fluid that was drained. Sometimes, lymphoma can develop in the lymph nodes in the chest area behind the breastbone and between the lungs. We would recommend asking the doctors specifically to explain their thinking and rationale. This may help you understand what is happening and if he is going to have any more investigations, such as a biopsy or bone marrow test. You could check if they are aware of his lymphoma history and ask if they have contacted a Haematologist for some advice.

I hope this information is helpful but if you have any more questions please don’t hesitate to get back in touch.

Best wishes,

Jo, Cancer Information Nurse Specialist 

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or email us. 

Ref/KG

Thank you for all your information.