Isseki Maeda1, Tatsuya Morita2, Takuhiro Yamaguchi3, Satoshi Inoue4, Masayuki Ikenaga5, Yoshihisa Matsumoto6, Ryuichi Sekine7, Takashi Yamaguchi8, Takeshi Hirohashi9, Tsukasa Tajima10, Ryohei Tatara11, Hiroaki Watanabe12, Hiroyuki Otani13, Chizuko Takigawa14, Yoshinobu Matsuda15, Hiroka Nagaoka16, Masanori Mori17, Yo Tei4, Ayako Kikuchi18, Mika Baba19, Hiroya Kinoshita6. 1. Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: maeda@pm.med.osaka-u.ac.jp. 2. Department of Palliative and Supportive Care, Palliative Care Team, Kita-ku, Hamamatsu, Shizuoka, Japan; Seirei Hospice, Seirei Mikatahara General Hospital, Kita-ku, Hamamatsu, Shizuoka, Japan. 3. Division of Biostatistics, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan. 4. Seirei Hospice, Seirei Mikatahara General Hospital, Kita-ku, Hamamatsu, Shizuoka, Japan. 5. Children's Hospice Hospital, Yodogawa Christian Hospital, Higashiyodogawa-ku, Osaka, Japan. 6. Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 7. Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan. 8. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. 9. Department of Palliative Care, Mitui Memorial Hospital, Chiyoda-ku, Tokyo, Japan. 10. Department of Palliative Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan. 11. Department of Palliative Medicine, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan. 12. Komaki City Hospital, Komaki, Aichi, Japan. 13. Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan. 14. Department of Palliative Care, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan. 15. Department of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan. 16. Department of Medical Social Service Center for Palliative Care, University of Tsukuba, Tsukuba, Ibaraki, Japan. 17. Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. 18. Department of Oncology, Mitsubishi Kyoto Hospital, Nishikyoku, Kyoto, Japan. 19. Palliative Care Division, Saito Yukoukai Hospital, Ibaraki, Osaka, Japan.
Abstract
BACKGROUND: Continuous deep sedation (CDS) before death is a form of palliative sedation therapy that has become a focus of strong debate, especially with respect to whether it shortens survival. We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival. METHODS: This study was a secondary analysis of a large multicentre prospective cohort study that recruited and followed up patients between Sept 3, 2012, and April 30, 2014, from 58 palliative care institutions across Japan, including hospital palliative care settings, inpatient palliative care units, and home-based palliative care services. Adult patients (aged ≥ 20 years) with advanced cancer who received care through the participating palliative care services were eligible for this secondary analysis. Patients with missing data for outcome variables or who lived for more than 180 days were excluded. We compared survival after enrolment between patients who did and did not receive CDS. We used a propensity score-weighting method to control for patient characteristics, disease status, and symptom burden at enrolment. FINDINGS: Of 2426 enrolled patients with advanced cancer, we excluded 289 (12%) for living longer than 180 days and 310 (13%) with missing data, leaving an analysis population of 1827 patients. 269 (15%) of 1827 patients received CDS. Unweighted median survival was 27 days (95% CI 22-30) in the CDS group and 26 days (24-27) in the no CDS group (median difference -1 day [95% CI -5 to 4]; HR 0·92 [95% CI 0·81-1·05]; log-rank p=0·20). After propensity-score weighting, these values were 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1·01 [95% CI 0·87-1·17]; log-rank p=0·91). Age (p(interaction)=0·67), sex (p(interaction)=0·26), performance status (p(interaction)=0·90), and volume of artificial hydration (p(interaction)=0·14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (p(interaction)=0·021). INTERPRETATION: CDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialised palliative care services, and could be considered a viable option for palliative care in this setting. FUNDING: Japanese National Cancer Center Research and Development Fund.
BACKGROUND: Continuous deep sedation (CDS) before death is a form of palliative sedation therapy that has become a focus of strong debate, especially with respect to whether it shortens survival. We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival. METHODS: This study was a secondary analysis of a large multicentre prospective cohort study that recruited and followed up patients between Sept 3, 2012, and April 30, 2014, from 58 palliative care institutions across Japan, including hospital palliative care settings, inpatient palliative care units, and home-based palliative care services. Adult patients (aged ≥ 20 years) with advanced cancer who received care through the participating palliative care services were eligible for this secondary analysis. Patients with missing data for outcome variables or who lived for more than 180 days were excluded. We compared survival after enrolment between patients who did and did not receive CDS. We used a propensity score-weighting method to control for patient characteristics, disease status, and symptom burden at enrolment. FINDINGS: Of 2426 enrolled patients with advanced cancer, we excluded 289 (12%) for living longer than 180 days and 310 (13%) with missing data, leaving an analysis population of 1827 patients. 269 (15%) of 1827 patients received CDS. Unweighted median survival was 27 days (95% CI 22-30) in the CDS group and 26 days (24-27) in the no CDS group (median difference -1 day [95% CI -5 to 4]; HR 0·92 [95% CI 0·81-1·05]; log-rank p=0·20). After propensity-score weighting, these values were 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1·01 [95% CI 0·87-1·17]; log-rank p=0·91). Age (p(interaction)=0·67), sex (p(interaction)=0·26), performance status (p(interaction)=0·90), and volume of artificial hydration (p(interaction)=0·14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (p(interaction)=0·021). INTERPRETATION:CDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialised palliative care services, and could be considered a viable option for palliative care in this setting. FUNDING: Japanese National Cancer Center Research and Development Fund.
Authors: Dietmar Weixler; Sophie Roider-Schur; Rudolf Likar; Claudia Bozzaro; Thomas Daniczek; Angelika Feichtner; Christoph Gabl; Bernhard Hammerl-Ferrari; Maria Kletecka-Pulker; Ulrich H J Körtner; Hilde Kössler; Johannes G Meran; Aurelia Miksovsky; Bettina Pusswald; Thomas Wienerroither; Herbert Watzke Journal: Wien Med Wochenschr Date: 2016-12-06
Authors: Sarah Ziegler; Margareta Schmid; Matthias Bopp; Georg Bosshard; Milo Alan Puhan Journal: J Gen Intern Med Date: 2018-03-20 Impact factor: 5.128
Authors: Margaux Vieille; Lionel Dany; Pierre Le Coz; Sophie Avon; Charlotte Keraval; Sébastien Salas; Cécile Bernard Journal: Palliat Med Rep Date: 2021-05-24