The 2025 revision of JPOS/JASCC clinical guidelines for delirium in adult patients with cancer: a summary of recommendations

BACKGROUND: The Japan Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer revised the clinical practice guidelines for delirium in adult patients with cancer in 2025. In this article, we describe the guideline revision and summarize the updated recommendations. METHODS: These guidelines were developed in accordance with the Minds Manual for Clinical Practice Guideline Development 2020. The multidisciplinary guideline development group formulated four new clinical questions (CQs) addressing delirium prevention (ramelteon and orexin receptor antagonists) and management (combination therapies of antipsychotics with either benzodiazepines or antihistamines). In addition, systematic reviews of 11 existing CQs were updated. RESULTS: Multicomponent interventions were strongly recommended for delirium prevention, based on moderate-certainty evidence. Bright light therapy, antipsychotics, ramelteon, and orexin receptor antagonists were not recommended for prevention. For delirium management, antipsychotics, trazodone, the combination of antipsychotics and benzodiazepines, and opioid switching were suggested, whereas hydroxyzine, benzodiazepines alone, and the combination of antipsychotics and antihistamines were not recommended. All recommendations for delirium management were weak, with low- to very-low-certainty evidence. Background questions addressed delirium assessment tools, precipitating factors, non-pharmacological interventions, and interventions for terminally ill patients. CONCLUSIONS: These revised clinical practice guidelines can serve as a practical framework for optimizing prevention, assessment, and management of delirium in adult patients with cancer in Japan.