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Blogger's Note: search blog for other articles regarding palliative sedation
Palliative Sedation in End-of-Life Care and Survival: A Systematic Review [Palliative and Supportive Care]:
Purpose
Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival.
Conclusion
Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.
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Sedation for the Management of Refractory Suffering
by Nathan Cherny
(Download file - duration 0:10:41, file size 9.80 MB)
This podcast presenter indicated no conflicts of interest.
Abstract
Purpose Palliative
sedation is a clinical procedure aimed at relieving refractory symptoms
in patients with advanced cancer. It has
been suggested that sedative drugs may shorten
life, but few studies exist comparing the survival of sedated and
nonsedated
patients. We present a systematic review of
literature on the clinical practice of palliative sedation to assess the
effect,
if any, on survival.
Methods A systematic
review of literature published between January 1980 and December 2010
was performed using MEDLINE and EMBASE
databases. Search terms included palliative
sedation, terminal sedation, refractory symptoms, cancer, neoplasm,
palliative
care, terminally ill, end-of-life care, and
survival. A manual search of the bibliographies of electronically
identified articles
was also performed.
Results Eleven
published articles were identified describing 1,807 consecutive patients
in 10 retrospective or prospective nonrandomized
studies, 621 (34.4%) of whom were sedated. One
case-control study was excluded from prevalence analysis. The most
frequent
reason for sedation was delirium in the terminal
stages of illness (median, 57.1%; range, 13.8% to 91.3%).
Benzodiazepines
were the most common drug category prescribed.
Comparing survival of sedated and nonsedated patients, the sedation
approach
was not shown to be associated with worse
survival.
Conclusion Even if
there is no direct evidence from randomized clinical trials, palliative
sedation, when appropriately indicated and
correctly used to relieve unbearable suffering,
does not seem to have any detrimental effect on survival of patients
with
terminal cancer. In this setting, palliative
sedation is a medical intervention that must be considered as part of a
continuum
of palliative care.
Footnotes
-
See accompanying editorial doi: 10.1200/JCO.2011.41.1223; listen to the podcast by Dr Cherny at www.jco.org/podcasts
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