title: Palliative sedation in patients with advanced cancer followed at home: a systematic review.
abstract: BACKGROUND
  Patients with advanced cancer who are near the end of life may experience intolerable suffering refractory to targeted palliative therapies. Palliative sedation (PS) is considered to be an effective treatment modality for these refractory symptoms when aggressive efforts fail to provide relief.
  
  
  OBJECTIVE
  The aim of this study was to systematically review articles regarding PS performed at home in patients with intractable symptoms.
  
  
  METHODS
  Literature databases searched included MedLine, PubMed, and EMBASE. The text words and MeSH/EMTREE terms "home care" and "sedation" were used for electronic database searches.
  
  
  RESULTS
  Six articles met the inclusion criteria for research and reported data regarding patients who were sedated at home. Although an early study reported a rate of more than 50%, the majority of the most recent literature, even though retrospective, shows an incidence of PS of 5%-36%. Agitated delirium, dyspnea, and pain were the most common problems requiring PS. The duration was variable (the mean across studies 1-3.5 days), and has not been statistically associated with hastened death. Benzodiazepines, specifically midazolam, have been most frequently used, alone or in combination with neuroleptics and opioids; in one article, opioids were given alone.
  
  
  CONCLUSIONS
  PS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home. Although the existing studies provide only low-quality evidence, the decision to use PS does not seem to anticipate patients' death. More homogeneous prospective studies on a large number of patients should confirm this observation.
authors.affiliation: Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valle
authors.forename: Flavio
authors.initials: F
authors.lastname: Fusco
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.forename: Veruska
authors.initials: V
authors.lastname: Costanzo
mesh_terms: D002986:Clinical Trials as Topic; D003693:Delirium / Q000188:drug therapy; D004417:Dyspnea / Q000188:drug therapy; D006699:Home Care Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives