Palliative Sedation in Patients With Advanced Cancer Followed at Home:         A Prospective Study.

Mercadante S, Porzio G, Valle A, Aielli F, Casuccio A; Home Care—Italy Group.

J Pain Symptom Manage. 2013 Oct 5. 

 Source

Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy; Palliative Medicine, Department of Anesthesia & Intensive Care, University of Palermo, Palermo, Italy. Electronic address: 03sebelle@gmail.com.

Abstract

CONTEXT:

Home care programs in Italy.

OBJECTIVES:

The aim of this study was to assess a protocol for palliative sedation (PS) performed at home.

METHODS:

A total of 219 patients were prospectively assessed to evaluate a PS protocol in patients with advanced cancer followed at home by two home care programs with different territorial facilities. The protocol was based on stepwise administration of midazolam.

RESULTS:

A total of 176 of the patients died at home, and PS was performed in 24 of these patients (13.6%). 

Younger patients received the procedure more frequently than older patients (P=0.012). 

The principal reasons to start PS were agitated delirium (n=20) and dyspnea (n=4). 

Mean duration of PS was 42.2±30.4 hours, and the mean doses of midazolam were 23-58mg/day. 

Both the home care team and the patients' relatives expressed optimal or good levels of satisfaction with the procedure in all but one case, respectively.

CONCLUSION:

This protocol for PS was feasible and effective in minimizing distress for a subgroup of patients who died at home. The characteristics of patients who may be effectively sedated at home should be better explored in future studies.

Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.