Palliative Sedation in End-of-Life Care and Survival: A Systematic Review

被引:208
作者
Maltoni, Marco [1 ]
Scarpi, Emanuela [1 ]
Rosati, Marta [2 ]
Derni, Stefania [2 ]
Fabbri, Laura [2 ]
Martini, Francesca [2 ]
Amadori, Dino [1 ]
Nanni, Oriana [1 ]
机构
[1] Ist Sci Romagnolo Studio & Cura Tumori, Meldola, Italy
[2] Azienda Unita Sanit Locale Forli, Forli, Italy
关键词
ADVANCED CANCER-PATIENTS; EUROPEAN-ASSOCIATION; THERAPY; HOSPICE; RECOMMENDATIONS; MULTICENTER; EUTHANASIA; SYMPTOMS;
D O I
10.1200/JCO.2011.37.3795
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:1378 / 1383
页数:6
相关论文
共 29 条
[1]   Slow euthanasia [J].
Billings, JA ;
Block, SD .
JOURNAL OF PALLIATIVE CARE, 1996, 12 (04) :21-30
[2]  
Broeckaert Bert., 2002, The Ethics of Palliative Care: European Perspective, P166
[3]  
Caraceni A, 2000, CANCER-AM CANCER SOC, V89, P1145, DOI 10.1002/1097-0142(20000901)89:5<1145::AID-CNCR24>3.0.CO
[4]  
2-X
[5]  
Cherny N I, 1994, J Palliat Care, V10, P31
[6]   European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care [J].
Cherny, Nathan I. ;
Radbruch, Lukas .
PALLIATIVE MEDICINE, 2009, 23 (07) :581-593
[7]   Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer - Report on a survey by the European Society of Medical Oncology Taskforce on Palliative and Supportive Care [J].
Cherny, NI ;
Catane, R .
CANCER, 2003, 98 (11) :2502-2510
[8]   Sedation for refractory symptoms of terminal cancer patients in Taiwan [J].
Chiu, TY ;
Hu, WY ;
Lue, BH ;
Cheng, SY ;
Chen, CY .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2001, 21 (06) :467-472
[9]   Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards [J].
De Graeff, Alexander ;
Dean, Mervyn .
JOURNAL OF PALLIATIVE MEDICINE, 2007, 10 (01) :67-85
[10]   Sedation for uncontrolled symptoms in a South African hospice [J].
Fainsinger, RL ;
Landman, W ;
Hoskings, M ;
Bruera, E .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1998, 16 (03) :145-152