Palliative sedation at home: A medical act practicable everywhere

Abstract

Background: Few studies regarding palliative sedation (PS) have been carried out in-home care (HC) setting. This study aimed to describe the prevalence of PS and its associated factors for end-of-life cancer patients sedated at home in a single institution for 12 months. Patients and methods: A retrospective study was carried out by the Tuscany Tumour Association including adult patients with a diagnosis of onco-haematologic disease, who had undergone palliative sedation at home (HPS) or not (non-HPS), in one year. Sociodemographic variables (sex and age) and clinical variables (primary tumour location, active treatment (AT) or best supportive care at the time of palliative sedation, causes of sedation, duration of sedation) were gathered from the clinical histories of the cohort of patients died at home. Results: From January to December 2018, 591 died at home mean age was 74 years ± 14 years, 311 (52%) patients were males, and 246 (42%) were still on AT. 110 (19%) received HPS. Dyspnoea (52%) and delirium (42%) were the main refractory symptoms leading to HPS. Univariate analysis showed a significant difference between HPS and non-HPS patients according to age and gender with younger (χ2 = 2.8, p = 0.0043) male (χ2 = 5.5, p = 0.019) patients more likely to undergo PS. Furthermore, adjusted odds ratios for each tumour showed that the risk of sedation was lower among patients with gastrointestinal cancer (OR adj = 0.59; 95% CI: 0.37–0.94), and higher for patients with melanoma (OR adj = 5.36; 95% CI: 1.35–21.24). Conclusions: This study confirms the feasibility and the important role as a therapeutic tool played by HPS in advanced cancer patients. It underlines the importance to pay particular attention to those patients more likely to undergo HPS (i.e. younger, males and/or melanoma patients), limiting useless or detrimental end-of-life antineoplastic treatments.