quality of life/supportive care/palliative care |
Palliative sedation therapy does not hasten death: results from a prospective multicenter study
1 Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli
2 Palliative Care Unit, Savignano sul Rubicone Hospice, Savignano sul Rubicone
3 Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola
4 Hospice Ospedaliero, Cancer Center, Modena
5 Palliative Care Unit, S. Domenico Hospice and Department of Medical Oncology, Umberto I Hospital, Lugo
6 Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
* Correspondence to: Dr M. Maltoni, Palliative Care Unit, Valerio Grassi Hospice, Via Duca d'Aosta 33, 47034 Forlimpopoli (FC), Italy. Tel: +39-0543-733332; Fax: +39-0543-733344; E-mail: ma.maltoni{at}ausl.fo.it
Background: Palliative sedation therapy (PST) is indicated for and used to control refractory symptoms in cancer patients undergoing palliative care. We aimed to evaluate whether PST has a detrimental effect on survival in terminally ill patients.
Methods: This multicenter, observational, prospective, nonrandomized population-based study evaluated overall survival in two cohorts of hospice patients, one submitted to palliative sedation (A) and the other managed as per routine hospice practice (B). Cohorts were matched for age class, gender, reason for hospice admission, and Karnofsky performance status.
Results: Of the 518 patients enrolled, 267 formed cohort A and 251 cohort B. In total, 25.1% of patients admitted to the participating hospices received PST. Mean and median duration of sedation was 4 (standard deviation 6.0) and 2 days (range 0–43), respectively. Median survival of arm A was 12 days [90% confidence interval (CI) 10–14], while that of arm B was 9 days (90% CI 8–10) (log rank = 0.95, P = 0.330) (unadjusted hazard ratio = 0.92, 90% CI 0.80–1.06).
Conclusion: PST does not shorten life when used to relieve refractory symptoms and does not need the doctrine of double effect to justify its use from an ethical point of view.
Key words: end-of-life care, hospice, palliative sedation, refractory symptom, survival
Received for publication July 8, 2008. Revision received November 11, 2008. Accepted for publication February 3, 2009.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. I Cherny, L. Radbruch, and The Board of the European Association for Palliati European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care Palliative Medicine, October 1, 2009; 23(7): 581 - 593. [Abstract] [PDF]
|
|
|
|
 |
|
 N. Cherny The use of sedation to relieve cancer patients' suffering at the end of life: addressing critical issues Ann. Onc., July 1, 2009; 20(7): 1153 - 1155. [Full Text] [PDF]
|
|