Palliative Sedation in Patients with Advanced Cancer Followed at Home: A Systematic Review

Context. Patients with advanced cancer who are near the end of life may experience intolerable suffering refractory to targeted palliative therapies. Palliative sedation (PS) is considered to be an effective treatment modality for these refractory symptoms when aggressive efforts fail to provide relief. Objectives. The aim of this study was to systematically review articles regarding PS performed at home in patients with intractable symptoms. Methods. Literature databases searched included MedLine, PubMed, and EMBASE. The text words and MeSH/EMTREE terms home care and sedation were used for electronic database searches. Results. Six articles met the inclusion criteria for research and reported data regarding patients who were sedated at home. Although an early study reported a rate of more than 50%, the majority of the most recent literature, even though retrospective, shows an incidence of PS of 5%-36%. Agitated delirium, dyspnea, and pain were the most common problems requiring PS. The duration was variable (the mean across studies 1-3.5 days), and has not been statistically associated with hastened death. Benzodiazepines, specifically midazolam, have been most frequently used, alone or in combination with neuroleptics and opioids; in one article, opioids were given alone. Conclusion. PS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home. Although the existing studies provide only low-quality evidence, the decision to use PS does not seem to anticipate patients' death. More homogeneous prospective studies on a large number of patients should confirm this observation. J Pain Symptom Manage 2011; 41: 754-760. (c) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.