title: Palliative sedation at home for terminally ill children with cancer.
abstract: BACKGROUND
  The presence of symptoms that are difficult to control always requires adjustment of treatment, and palliative sedation (PS) should be considered.
  
  
  OBJECTIVE
  We analyzed our experience in conducting PS at home for terminally ill children with cancer during a seven-year period.
  
  
  METHODS
  We performed a retrospective analysis of medical records of children with cancer treated at home between the years 2005 and 2011.
  
  
  RESULTS
  We analyzed the data of 42 cancer patients (18% of all patients); in 21 cases, PS was initiated (solid tumors n = 11, brain tumors [5], bone tumors [4], leukemia [1]). Sedation was introduced because of pain (n = 13), dyspnea (9), anxiety (5), or two of those symptoms (6). The main drug used for sedation was midazolam; all patients received morphine. There were no significant differences in the dose of morphine or midazolam depending on the patient's sex; age was correlated with an increase of midazolam dose (R = 0.68; P = 0.005). Duration of sedation (R = 0.61; P = 0.003) and its later initiation (R = 0.43; P = 0.05) were correlated with an increase of the morphine dose. All patients received adjuvant treatment; in patients who required a morphine dose increase, metoclopramide was used more often (P = 0.0002). Patients did not experience any adverse reactions. Later introduction of sedation was associated with a marginally higher number of intervention visits and a significantly higher number of planned visits (R = 0.53; P = 0.013).
  
  
  CONCLUSIONS
  Sedation may be safely used at home. It requires close monitoring and full cooperation between the family and hospice team. Because of the limited data on home PS in pediatric populations, further studies are needed.
authors.affiliation: Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Gajusz Foundation, Pediatric Palliative Care Center - Home Hospice for Children of Lodz Region, Lodz, Poland. Electronic address: aleksandra.korzeniewska-eksterowicz@umed.lodz.pl.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Korzeniewska-Eksterowicz
authors.affiliation: Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Gajusz Foundation, Pediatric Palliative Care Center - Home Hospice for Children of Lodz Region, Lodz, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Przysło
authors.affiliation: Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Fendler
authors.affiliation: Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Gajusz Foundation, Pediatric Palliative Care Center - Home Hospice for Children of Lodz Region, Lodz, Poland; Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stolarska
authors.affiliation: Pediatric Palliative Care Unit, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Młynarski
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006699:Home Care Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D019452:Terminally Ill; D013997:Time Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam
keywords: Palliative sedation; children; end of life; home care; palliative care