Sedation may not hasten death for terminal cancer patients

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Terminal cancer patients who receive continuous deep sedation to ease pain at the end of life might not die any sooner than people who don't get this type of palliative care, a Japanese study suggests.

Even though continuous deep sedation has been used for decades to relieve suffering for the terminally ill, previous research has yielded mixed results on whether it shortens patient survival - especially if the powerful narcotics are provided without artificial hydration to prevent patients from dying of thirst.

This possibility makes the decision all the more agonizing for families who must weigh making their loved ones comfortable against the potential to make matters worse, said lead study author Dr. Isseki Maeda, a researcher at Osaka University Graduate School of Medicine in Japan.

"Bereaved families often feel guilty and wonder if they could do more for the patient," Maeda said by email. "If they believed sedation shortened survival, their guilty feeling may become deeper. Our study indicated that continuous deep sedation did not shorten patient life or change patient's dying process."

For the current study, Maeda and colleagues analyzed data on 1,827 patients with terminal cancer, including 269 who received continuous deep sedation, to see how long they survived after being enrolled in a palliative care program.

With sedation, patients lived around 22 days, compared to about 26 days without sedation, a difference that was too small after adjusting for individual characteristics to rule out the possibility that it was due to chance.

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Roughly 60 percent of patients received artificial hydration near the end of life, regardless of whether they got continuous deep sedation.

The amount of artificial hydration provided didn't appear to alter the connection between use of sedation and survival, the study found. Hydration was administered less often at home than in the hospital or palliative care unit.

One limitation of the study, the authors acknowledge in Lancet Oncology, is that researchers lacked data on sedation practices used on individual patients. It's also unlikely that the findings would be the same for terminal patients who didn't have cancer or who weren't treated by palliative care specialists.

Still, the findings should help put to rest ethical questions about whether continuous deep sedation at the end of life amounts to a form of euthanasia, because this type of care wasn't linked to more rapid death, writes Dr. Augusto Caraceni, a palliative care researcher at the Norwegian University of Science and Technology in Trondheim, in an accompanying editorial.

While more research is needed to explore the role of sedation in palliative care for diseases other than cancer, the results should offer reassurance to families wrestling with the best way to care for a terminally ill loved one, Caraceni told Reuters Health by email.

"Reducing the patient level of consciousness to the point of compromising his or her ability to communicate and to share with his or her loved ones is not a light decision to be taken, and it should be regarded as a last resort solution," he said.

"On the other hand, families may feel reassured that by offering sedation we are relieving suffering and fulfilling our obligation to care for the patient until the very end," Caraceni added.