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Palliative sedation in patients with advanced cancer in a specialized unit in a middle-income country: A retrospective cohort study

Published online by Cambridge University Press:  24 August 2021

Carolina Záu Serpa de Araujo Open the ORCID record for Carolina Záu Serpa de Araujo [Opens in a new window] ,
Laís Záu Serpa de Araújo Open the ORCID record for Laís Záu Serpa de Araújo [Opens in a new window]  and
Antonio Paulo Nassar Junior Open the ORCID record for Antonio Paulo Nassar Junior [Opens in a new window]
Carolina Záu Serpa de Araujo
Affiliation:
Palliative Care Unit, Santa Casa de Misericordia, Maceió, Brazil
Laís Záu Serpa de Araújo
Affiliation:
Discipline of Bioethics, Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, Brazil
Antonio Paulo Nassar Junior*
Affiliation:
A.C. Camargo Cancer Center, São Paulo, Brazil
*
Author for correspondence: Antonio Paulo Nassar Junior, Rua Professor Antonio Prudente, 211-6th floor, CEP 01509-010 São Paulo, Brazil. E-mail: [email protected]
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Abstract

Objective

To describe the 5-year practice on palliative sedation in a specialized palliative care unit in a deprived region in Brazil, and to compare survival of patients with advanced cancer who were and were not sedated during their end-of-life care.

Method

Retrospective cohort study in a tertiary teaching hospital. We described the practice of palliative sedation and compared the survival time between patients who were and were not sedated in their last days of life.

Results

We included 906 patients who were admitted to the palliative care unit during the study period, of whom, 92 (10.2%) received palliative sedation. Patients who were sedated were younger, presented with higher rates of delirium, and reported more pain, suffering, and dyspnea than those who were not sedated. Median hospital survival of patients who received palliative sedation was 9.30 (CI 95%, 7.51–11.81) days and of patients who were not sedated was 8.2 (CI 95%, 7.3–9.0) days (P = 0.31). Adjusted for age and sex, palliative sedation was not significantly associated with hospital survival (hazard ratio = 0.93; CI 95%, 0.74–1.15).

Significance of results

Palliative sedation can be accomplished even in a deprived area. Delirium, dyspnea, and pain were more common in patients who were sedated. Median survival was not reduced in patients who were sedated.

Keywords

CancerCancer care facilitiesDeep sedationEnd-of-life carePalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 4 , August 2022 , pp. 491 - 495
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

REFERENCES

Abarshi, E, Rietjens, J, Robijn, L, et al. (2017) International variations in clinical practice guidelines for palliative sedation: A systematic review. BMJ Supportive & Palliative Care 7(3), 223–229.Google ScholarPubMed
Arantzamendi, M, Belar, A, Payne, S, et al. (2021) Clinical aspects of palliative sedation in prospective studies. A systematic review. Journal of Pain and Symptom Management 61(4), 831–844.e10.CrossRefGoogle ScholarPubMed
Beller, EM, van Driel, ML, McGregor, L, et al. (2015) Palliative pharmacological sedation for terminally ill adults. Cochrane Database of Systematic Reviews 1(1), Cd010206.Google ScholarPubMed
Benítez-Rosario, MA and Ascanio-León, B (2020) Palliative sedation: Beliefs and decision-making among Spanish palliative care physicians. Supportive Care in Cancer 28(6), 2651–2658.CrossRefGoogle ScholarPubMed
Bobb, B (2016) A review of palliative sedation. Nursing Clinics of North Amercia 51(3), 449–457.CrossRefGoogle ScholarPubMed
Born, W, Greiner, KA, Sylvia, E, et al. (2004) Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. Journal of Palliative Medicine 7(2), 247–256.CrossRefGoogle ScholarPubMed
Cherny, NI (2014) ESMO clinical practice guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Annals of Oncology 25(Suppl 3), iii143–iii152.CrossRefGoogle ScholarPubMed
Díez-Manglano, J, Isasi de Isasmendi Pérez, S, García Fenoll, R, et al. (2020) Palliative sedation in patients hospitalized in internal medicine departments. Journal of Pain and Symptom Management 59(2), 302–309.CrossRefGoogle ScholarPubMed
Heijltjes, MT, van Thiel, G, Rietjens, JAC, et al. (2020) Changing practices in the use of continuous sedation at the end of life: A systematic review of the literature. Journal of Pain and Symptom Management 60(4), 828–846.e823.CrossRefGoogle ScholarPubMed
Maeda, I, Morita, T, Yamaguchi, T, et al. (2016) 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 Oncology 17(1), 115–122.CrossRefGoogle ScholarPubMed
Maltoni, M, Scarpi, E, Rosati, M, et al. (2012) Palliative sedation in end-of-life care and survival: A systematic review. Journal of Clinical Oncology 30(12), 1378–1383.CrossRefGoogle ScholarPubMed
Menezes, MS and Figueiredo, M (2019) The role of end-of-life palliative sedation: Medical and ethical aspects - Review. Revista Brasileira de Anestesiology 69(1), 72–77.Google Scholar
Monreal-Carrillo, E, Allende-Pérez, S, Hui, D, et al. (2017) Bispectral index monitoring in cancer patients undergoing palliative sedation: A preliminary report. Supportive Care in Cancer 25(10), 3143–3149.CrossRefGoogle ScholarPubMed
Parra Palacio, S, Giraldo Hoyos, CE, Arias Rodríguez, C, et al. (2018) Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit. Supportive Care in Cancer 26(9), 3173–3180.CrossRefGoogle Scholar
Piedade, MAO, Cardoso Filho, CA and Priolli, DG (2020) Prevalence of palliative sedation in the State of São Paulo: An emerging medical demand. Einstein (Sao Paulo) 18, eAO5395.CrossRefGoogle Scholar
Prado, BL, Gomes, DBD, Usón Júnior, PLS, et al. (2018) Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliative Care 17(1), 13.CrossRefGoogle Scholar
Rodrigues, P, Menten, J and Gastmans, C (2020) Physicians’ perceptions of palliative sedation for existential suffering: A systematic review. BMJ Supportive & Palliative Care 10(2), 136–144.CrossRefGoogle ScholarPubMed
Silva, GAE, Jardim, BC, Ferreira, VM, et al. (2020) Cancer mortality in the capitals and in the interior of Brazil: A four-decade analysis. Revista de Saúde Pública 54, 126.CrossRefGoogle ScholarPubMed
Soto-Perez-de-Celis, E, Chavarri-Guerra, Y, Pastrana, T, et al. (2017) End-of-life care in Latin America. Journal of Global Oncology 3(3), 261–270.CrossRefGoogle ScholarPubMed
Spineli, VM, Kurashima, AY and De Gutiérrez, MG (2015) The process of palliative sedation as viewed by physicians and nurses working in palliative care in Brazil. Palliative & Supportive Care 13(5), 1293–1299.CrossRefGoogle ScholarPubMed
Spoljar, D, Curkovic, M, Gastmans, C, et al. (2020) Ethical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review. Journal of Critical Care 58, 10–19.CrossRefGoogle ScholarPubMed
Sprung, CL, Ricou, B, Hartog, CS, et al. (2019) Changes in end-of-life practices in European intensive care units from 1999 to 2016. JAMA 322(17), 1–12.CrossRefGoogle ScholarPubMed
Vale, DB, Sauvaget, C, Muwonge, R, et al. (2016) Disparities in time trends of cervical cancer mortality rates in Brazil. Cancer Causes & Control 27(7), 889–896.CrossRefGoogle ScholarPubMed
Voeuk, A, Nekolaichuk, C, Fainsinger, R, et al. (2017) Continuous palliative sedation for existential distress? A survey of Canadian palliative care physicians’ views. Journal of Palliative Care 32(1), 26–33.CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, et al. (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology 61(4), 344–349.CrossRefGoogle ScholarPubMed
Yaguchi, A, Truog, RD, Curtis, JR, et al. (2005) International differences in end-of-life attitudes in the intensive care unit: Results of a survey. Archives of Internal Medicine 165(17), 1970–1975.CrossRefGoogle ScholarPubMed