Continuous Palliative Sedation for Cancer and Noncancer Patients

• Published in: Journal of pain and symptom management Vol. 43; no. 2; pp. 172 - 181
• Main Authors: Swart, Siebe J., MD, Rietjens, Judith A.C., PhD, van Zuylen, Lia, MD, PhD, Zuurmond, Wouter W.A., MD, PhD, Perez, Roberto S.G.M., PhD, van der Maas, Paul J., MD, PhD, van Delden, Johannes J.M., MD, PhD, van der Heide, Agnes, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; Cancer; Comorbidity; continuous sedation until death; decision making; disease trajectories; Doctors; Dying people; Euthanasia; Female; Humans; Hypnotics and Sedatives - administration & dosage; Male; Medical sciences; Middle Aged; Neoplasms - mortality; Neoplasms - nursing; Netherlands - epidemiology; noncancer; Pain - mortality; Pain - prevention & control; Pain Medicine; Palliative care; Palliative Care - utilization; palliative sedation; Pharmacology. Drug treatments; Practice Patterns, Physicians' - statistics & numerical data; Prevalence; Sedation; Surveys and Questionnaires; Survival Analysis; Survival Rate; Terminal Care - utilization; Terminally Ill - statistics & numerical data; Treatment Outcome; Netherlands; disease trajectories; continuous sedation until death; noncancer; palliative sedation; decision making; Cancer; Human; Continuous; Decision making; Mortality; Death; Sedation; Malignant tumor
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2011.04.004

Abstract Context Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. Objectives To study the practice of continuous palliative sedation for both cancer and noncancer patients. Methods In 2008, a structured questionnaire was sent to 1580 physicians regarding their last patient receiving continuous sedation until death. Results A total of 606 physicians (38%) filled out the questionnaire, of whom 370 (61%) reported on their last case of continuous sedation (cancer patients: n = 282 [76%] and noncancer patients: n = 88 [24%]). More often, noncancer patients were older, female, and not fully competent. Dyspnea (odds ratio [OR] = 2.13; 95% confidence interval [CI]: 1.22, 3.72) and psychological exhaustion (OR = 2.64; 95% CI: 1.26, 5.55) were more often a decisive indication for continuous sedation for these patients. A palliative care team was consulted less often for noncancer patients (OR = 0.45; 95% CI: 0.21, 0.96). Also, preceding sedation, euthanasia was discussed less often with noncancer patients (OR = 0.42; 95% CI: 0.24, 0.73), whereas their relatives more often initiated discussion about euthanasia than relatives of cancer patients (OR = 3.75; 95% CI: 1.26, 11.20). Conclusion The practice of continuous palliative sedation in patients dying of cancer differs from patients dying of other diseases. These differences seem to be related to the less predictable course of noncancer diseases, which may reduce physicians’ awareness of the imminence of death. Increased attention to noncancer diseases in palliative care practice and research is, therefore, crucial as is more attention to the potential benefits of palliative care consultation.