Continuous Deep Sedation In Advanced Cancer Patients ‘Does Not Hasten Death’

The addition of continuous deep sedation to palliative care for advanced cancer does not shorten patient survival

  • Date: 27 Nov 2015
  • Author: By Lynda Williams, Senior medwireNews Reporter
  • Topic: Palliative Care

medwireNews: Continuous deep sedation (CDS) does not significantly shorten the life of advanced cancer patients who are cared for by specialist palliative services, Japanese researchers show.

“This finding might alleviate concerns and feelings of guilt that families and clinicians might have when deciding whether to give a patient CDS”, say Isseki Maeda, from Osaka University Graduate School of Medicine, and co-authors in The Lancet Oncology.

The team used propensity score-weighted analysis to compare survival of 1827 patients with advanced cancer who received palliative care between September 2012 and April 2014 at one of 58 institutions in Japan and died within 180 days.

Median survival was a comparable 27 days for the 15% of patients who received CDS versus 26 days for those who were not given palliative sedation. And propensity score-weighting analysis confirmed that there was no significant difference in survival, giving a median of 22 days and 26 days.

Of note, the association between survival and CDS was not significantly influenced by patient age, gender or performance status, or by the use and volume of artificial hydration.

Patients who were admitted to palliative care units had a greater burden of symptoms and shorter survival than those given palliative treatment by a hospital service or at home. And care setting was significantly associated with survival, with a hazard ratio in favour of CDS at home but in favour of no CDS use in hospital.

Augusto Caraceni, from Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, writes in an accompanying comment that the findings support guidelines recommending that CDS should be administered by, or in consultation with, a palliative care specialist.

“The excessive attention to the theoretical death-hastening effect of palliative sedation has under-estimated the importance of promoting knowledge and clinical studies about this procedure, and overlooked the need to distinguish between different methods of sedation”, he observes, emphasising the need for research to identify the optimal use of CDS for the care of patients with differing conditions and symptoms.

References

Maeda I, Morita T, Yamaguchi T, et al. Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study. Lancet Oncol 2015; Advance online publication 20 November. DOI: http://dx.doi.org/10.1016/S1470-2045(15)00401-5

Caraceni A. Palliative sedation: more data and fewer opinions. Lancet Oncol 2015; Advance online publication 20 November. DOI: http://dx.doi.org/10.1016/S1470-2045(15)00532-X

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