Palliative Sedation Has No Effect on Survival in Patients with Terminal Cancer
(ChemotherapyAdvisor) – Palliative sedation has no detrimental effect on survival of patients with terminal cancer and, in this setting, “is a medical intervention that must be considered as part of a continuum of palliative care,” a study concluded in the Journal of Clinical Oncology online March 12.
While palliative sedation can relieve refractory symptoms in patients with advanced cancer, there is some concern that sedative drugs may shorten life; however, few studies have compared survival of sedated and nonsedated patients. The investigators conducted a systematic review of the literature on the clinical practice of palliative sedation between January 1980 and December 2010 to assess the effect, if any, on survival.
Of eleven articles identified, there were seven retrospective and three prospective nonrandomized studies of 1,807 consecutive patients, 621 of whom (34.4%) were sedated. A median of 57.1% of patients (range, 13.8% to 91.3%) were sedated for delirium in the terminal stages of illness, the most frequent reason for sedation. The most common drug category prescribed was benzodiazepines. “Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival,” they found.
Despite lack of direct evidence from randomized clinical trials, appropriate indication and correct use of palliative sedation to “relieve unbearable suffering,” is warranted in this patient population, they concluded.
An accompanying editorial noted that most of the studies identified in this systematic review were conducted in palliative-care units and thus might not be applicable to the practice of palliative sedation in regular hospital wards. “It is important that all clinical settings where palliative sedation is performed also measure delirium and symptom distress on a regular basis,” the author noted.