P18.07 * PALLIATIVE SEDATION FOR BRAIN TUMOR PATIENTS AT THE END OF LIFE

Abstract

BACKGROUND: Therapeutic (or palliative) sedation in the context of palliative medicine is the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and health-care providers. There is a large debate about the use of palliative sedation, sometime defined as terminal sedation. There are very few data about the role of palliative sedation in brain tumor patients at the end of life. However, in brain tumor patients palliative sedation may be necessary in case of uncontrolled delirium, agitation, death rattle or refractory seizures. METHODS: We retrospectively analyzed the clinical records of patients assisted at home until death by the Regina Elena Cancer Institute Palliative Home Care for brain tumor patients. All patients died for brain tumor in the last 2 years (2012-2013) were included in this study. RESULTS: Out of 190 brain tumor patients assisted at home in 2012-2013, 108 died and were included in this study. All patients were affected by malignant glioma. Palliative sedation was utilized in 12 cases (11%). In 8 cases for the control of refractory seizures and in 4 cases for delirium. Given the lack of advanced directives and low competence of patients, the decision about sedation was discussed by the care team with caregivers and family members. Palliative sedation was started with midazolam 0.5-1 mg/hr and prolonged until symptoms' control. CONCLUSION: The use of palliative sedation is relatively frequent in the practice of a neuro-oncologic palliative team. The most frequent refractory symptoms in this population of patients were seizures and delirium. The process of end of life treatment decisions in neuro-oncology requires to be better defined.