Retrospective Survey of Palliative Sedation Therapy at the End-of-life at a Tertiary Cancer Center in Japan

Shuntaro Yasuda; Marie Nishikawa; Hiromi Takada; Hiroto Ishiki; Daisuke Kiuchi; Masaki Shimizu; Eriko Satomi; Ken Shimizu; Masakazu Yamaguchi

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Retrospective Survey of Palliative Sedation Therapy at the End-of-life at a Tertiary Cancer Center in Japan

VernacularTitle:がん専門病院における終末期の苦痛緩和のための鎮静の施行状況に関する後方視的調査
Author: Shuntaro YASUDA ¹ ; Marie NISHIKAWA ¹ ; Hiromi TAKADA ² ; Hiroto ISHIKI ³ ; Daisuke KIUCHI ⁴ ; Masaki SHIMIZU ⁴ ; Eriko SATOMI ⁴ ; Ken SHIMIZU ⁴ ; Masakazu YAMAGUCHI ⁴
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1. Department of Pharmacy, National Cancer Center Hospital
2. Department of Pharmacy, Center Hospital of the National Center for Global Health and Medicine
3. Department of Nursing, National Cancer Center Hospital
4. Department of Palliative Medicine, National Cancer Center Hospital
Keywords: palliative sedation therapy; tertiary cancer center; rare cancer; adolescent and young adult; palliative care team
From:Palliative Care Research 2020;15(1):43-50
CountryJapan
Language:Japanese
Abstract: Although palliative sedation therapy (PST) is considered to alleviate intolerable and refractory symptoms in dying patients with advanced cancer, there have been few studies regarding the situation of tertiary cancer center. We conducted a retrospective survey of the medical records of the patients who died between April 2015 and March 2016 at the National Cancer Center Hospital in Japan. PST was conducted in 75 out of 431 patients (17.4%). The patient demographics were as follows: sex (male/female), 48/27; median age, 61 years (range 5-83; 11 patients (14.7%) were aged under 39 years); and primary sites were lung, 18 (24.7%)/ pancreas, 11 (14.7%)/ hematopoietic organs, 11 (14.7%)/ bones and soft tissues, 8 (10.7%)/ and the others, 27 (36.0%). The main target symptoms for PST were dyspnea (38, 50.7%) and delirium (30, 40.0%). The most commonly used sedative agent was midazolam (72, 96.0%). Continuous deep sedation was intended in 61 patients (81.3%) at the death. Median survival from the start of PST were 2 days (range 0-54). The differences between palliative care team (PCT) intervention group and control group were lower age (58 vs. 62.5, P=0.048) and uniformity of initial midazolam dose (5-12 vs. 9.6-25.2 mg/day). Distinctive feature in this study was large proportion of adolescent and young adult patients with rare cancers. PCT might have different approaches to sedation in comparison to non-PCT medical staffs.