1348P - A nationwide survey on palliative sedation for terminally ill cancer patients by the Austrian Palliative Care (AUPAC) study group

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Palliative Care
Presenter Sophie Schur
Citation Annals of Oncology (2014) 25 (suppl_4): iv471-iv477. 10.1093/annonc/mdu350
Authors S. Schur, E.K. Masel, M. Mayrhofer, H. Watzke
  • Clinical Division Of Palliative Care, Department For Internal Medicine I, Medical University of Vienna, 1090 - Vienna/AT

Abstract

Aim

Palliative sedation (PS) is defined as the controlled use of sedative drugs to alleviate unbearable suffering caused by refractory symptoms. Intractable distress longing for subsequent sedating treatment may frequently occur especially in oncological patients in the terminal phase of illness. Application of this approach requires special expertise but consensus on best practice is achieved incompletely. The aim of this study was to assess the current practice of PS in Austria.

Methods

Data on sedation were retrieved of all patients who died at an AUPAC (Austrian Palliative Care) study group unit between June 2012 and June 2013. Besides clinical characteristics, frequency, duration, indication and medication of PS in the last two weeks of life were evaluated. Furthermore co-medications given in the last three days before death were recorded.

Results

In total 1994 cancer patients died at 22 AUPAC units in the study period. 22.4% (range 0-50%, n = 435) received PS in the last two weeks of their lives. The main indications for PS were delirium (48.5%), existential suffering (34%), refractory dyspnea (28%) and pain (20.2%). 73.6% of all patients received deep continuous sedation and 22.3% transient sedation. The drugs used for sedation were midazolam (77.7%), lorazepam (14.7%) and haloperidol (10.1%). 33.8% of all patients were sedated only in the last 24 hours before death. The following co-medications were given concomitant to palliative sedation in the last three days of life: non-opioids (49.9%), opioids (96.1%), i.v. antibiotics (20.2%), deep venous thrombosis prophylaxis (24.4%), hydration (54.5%) and nutrition (24.4%). Sedated patients were significantly younger than non-sedated ones (p = ,000*) and the percentage of male patients was significantly higher in the sedated group (p = ,043*). There was no detectable difference in survival time between sedated and non-sedated patients.

Conclusions

There is a considerable heterogeneity in the use of PS in oncological patients in Austrian palliative care units which cannot be explained by disease associated variables. Since the use of PS is associated with significant ethical issues, training of physicians and implementation of an Austrian nation-wide guideline is mandatory.

Disclosure

All authors have declared no conflicts of interest.