Palliative sedation and time to death in home palliative care: retrospective analysis

Correspondence to Dr Daniele Marinelli, Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Out-of-hospital palliative care interventions reduce patients’ distress and meet the critical need of reducing in-hospital stay during end-of-life care; palliative sedation is aimed at relieving refractory symptoms by reducing the patient’s consciousness through pharmacological intervention without detrimental effect on survival time.

WHAT THIS STUDY ADDS

• This study showed that a significant fraction (~38% of patients included in the analysis) underwent palliative sedation at home due to refractory symptoms, most commonly delirium and dyspnoea. Eastern Cooperative Oncology Group performance status and receipt of anticancer treatment at home palliative care admission impacted survival time.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Precision palliative care tailored to each patient’s specific needs is critical to improve both objective and subjective outcome measures in end-of-life care. This study adds knowledge on predictors of survival time and usage of palliative sedation in home palliative care.

Introduction

While significant improvements were achieved in the last 15 years in the landscape of active anticancer treatment, palliative care stands as a cornerstone in the management of patients with advanced cancer.¹ Early integration of palliative care led to improvements in quality of life and was associated with improved overall survival (OS) in advanced non-small cell lung cancer^2–4; still, systematic screening of patients with advanced cancer showed that palliative care needs may differ significantly, thus requiring the development of precision palliative care clinical workflows.^{5 6} While some patients with advanced cancer and extremely long OS may need palliative care interventions at later stages of the disease, cancer-related or cancer-independent frailty and symptoms often characterise patients for whom palliative care may be of greatest benefit.⁷

Out-of-hospital palliative care interventions through the integration of community and hospital care are able to minimise patients’ distress and meet the critical need of reducing in-hospital stay during end-of-life care; furthermore, home palliative care in patients undergoing active anticancer treatment may obviate the need for multiple hospital admissions in case of treatment-related toxicity or worsening of general conditions.^{1 8}

In the continuum of end-of-life care, palliative sedation is aimed at relieving refractory symptoms by reducing the patient’s consciousness...