Palliative Sedation Therapy Does Not Hasten Death

Palliative sedation therapy used for the control of refractory symptoms in cancer patients with very advanced disease does not hasten death, a new study concludes.

Researchers at Valerio Grassi Hospice (Forlimpopoli, Italy) recruited 518 patients from 4 hospices in the Emilia-Romagna region of Italy. The patients were divided into two cohorts (A and B) that were matched for age, sex, Karnofsky performance status, reason for hospice admission, and predicted survival; the two cohorts differed only in terms of one characteristic - sedation. The most common cancers were lung, colorectal, stomach, breast, and pancreas, and the most common metastases were in the liver, lymph nodes, and bone; there were no statistically significant differences in the location of the primary tumor or metastases. Drugs used for palliative sedation included neuroleptics such as chlorpromazine, promethazine, and haloperidol, benzodiazepines such as lorazepam, midazolam, and diazepam, and opioids such as morphine.

The results showed that the overall prevalence of palliative sedation therapy in the patients who were admitted to these hospices was 25.1%, with very little variability among the centers (5%). Mean and median duration of sedation was four days for cohort A and two days for cohort B. The median survival of arm A was 12 days, while that of arm B was 9 days. In fact, the overall survival curves of the two cohorts were superimposable, the researchers reported. The study was published in the July 2009 issue of the Annals of Oncology.

"I think that many physicians think that palliative sedation therapy is or could be a form of 'slow' or 'soft' euthanasia," said lead author Marco Marco Maltoni, M.D., director of the Valerio Grassi Hospice. "But the results of this new study show that the therapy does not have a detrimental effect on survival. I would say that our results may help physicians and patients who do not accept euthanasia to have a good clinical practice, so that no patient is forced to reach death in a symptomatic way.”

Delirium and/or agitation were cited the most often as reasons for palliative therapy (78.7% of patients), followed by dyspnea (19.5% of patients), pain (11.2%), and vomiting (4.5%). Refractory psychological distress was cited in 18.7% of patients, but the majority of this group also presented with physical refractory symptoms.

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Valerio Grassi Hospice