Palliative sedation for cancer patients in a tertiary palliative care unit in Argentina

VEGA, FANNY; DRAN, GRACIELA; MAMMANA, GUILLERMO; CULLEN, CLARA; BIONDI, CYNTHIA; PASTRANA, TANIA; CAMERANO, GABRIELA VERÓNICA; RUGGIERO, RAÚL; ARMESTO, ARNALDO; BERTOLINO, MARIELA

Viena

Congreso; 18th ECCO - 40th ESMO European Cancer Congress; 2015

There is wide variation in the praxis and frequency of Palliative Sedation (PS) for controlling intractable and refractory symptoms at end of life. The aim of this study was to explore different aspects of the practice of PS among patients who underwent this intervention in a Tertiary Palliative Care Unit (PCU) in Argentina. Materials and methods This retrospective study reviewed charts of all inpatients of the PCU between January 2011 and December 2014, identifying those who received PS. Socio-demographic and clinical data as well as indications for sedations, drugs and survival time were collected. Results A total of 319 inpatients were admitted and 131 (41%) received PS. Compared with non-sedated patients, no statistic significant differences were found in demographics, baselines Eastern Oncology Cooperative Group, Palliative Performance Scale and Palliative Prognostic Index scores, last 24 hours- Edmonton Comfort Assessment Form and length of hospitalization. In the group of patients who received PS, the mean age was 61.9±14,1, 54% were male and 86% had ECOG 4. 97 % had oncological condition, being cancer of unknown primary origin (65%) and lung cancer (51%) the most frequent. Dyspnea was the main cause for hospitalization. The average survival time from admission was 13.1±18.4 days . The most common indications for PS were refractory delirium (66%) and refractory dyspnea (29%). Midazolam was used in 91% of the cases (range: 34-68mg/day), in 48% a combination of two or more medications (mostly Midazolam+Levomepromazine) was applied. The sedation therapy was mostly in the beginning superficial (70%) with later transition to deep- continuous PS (62%). The average duration for PS was 3.5±2.0 days. The most frequent opioids intra PS were Fentanyl (58%) and Morphine (32%), with oral MEDD 57.1 ME. Regarding the treatment prior to PS, neuroleptics (Haloperidol 48% and Levomepromazine 27%) were used to control delirium-related symptoms in 75% of the cases and other benzodiazepines (Lorazepam 22% and Clonazepam 22% ) were administered to control anxiety, insomnia, etc, in 44% of the patients. In 97% of the cases, family (62%) or both patients and family (35%) agreed to the sedative intervention (the remaining 3% was not registered). Conclusions: Palliative sedation was required in an important proportion of patients (41%), according to the prevailing severe conditions and poor prognostic refractory symptoms of inpatients at the tertiary PCU. The main causes for PS were dyspnea and delirium, and the preferred medication was Midazolam. Patients with diagnosis of lung cancer and cancer of unknown primary origin required significantly more PS than the other cancer types. The end-of-life decision making process was achieved with almost complete agreement of patients and/or families