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KMID : 1039620140040020137
Korean Journal of Family Practice
2014 Volume.4 No. 2 p.137 ~ p.142
Use of Palliative Sedation for Intractable Symptoms in the Hospice Palliative Care Unit
Kim Ju-Young

Min Hong-Gi
Kang Myung-Ku
Cho Gi-Chul
Bae Sul-Yun
Baik Dong-Wook
Shin Ha-Ni
Oh Sang-Jong
Abstract
Background: Palliative sedation (PS) is an option of last resort to control intractable and refractory symptoms in terminal cancer patients. But the frequency of use of PS is variable. We describe the frequency and outcomes of PS in one hospice palliative care unit.

Methods: We performed a retrospective analysis of medical records of 116 cancer patients who were admitted to the hospice care unit in the department of family medicine at Busan Medical Center, between October 2009 and January 2011. Information on demographics, refractory symptoms requiring PS, and agent used for PS were reviewed and analyzed.

Results: Of all included patients (n=116), 44.8% received PS. The mean age of the PS group was 69.4 years. The most frequent primary malignancy observed in PS patients was lung cancer (21.2%). In the PS group, 36 patients (69.2%) had distant metastasis compared with 26 patients (40.6%) in the non-sedated group (P<0.01). The most frequent refractory symptoms in the PS group were delirium (39%) and pain (27.1%) alone or combined with other symptoms, and the drugs most frequently used for PS were lorazepam (54.1%), haloperidol (40.5%), and diazepam (4.1%) alone or combined with other drugs. When three levels of sedation were distinguished as mild, intermediate, or deep, intermediate level was most
observed with 34 patients (65.4%), followed by mild and deep (11 patients [21.2%], and 7 patients [13.5%], respectively).

Conclusion: PS was required in 44.8% of hospice palliative care. PS is an important intervention to control refractory symptoms experienced by terminal cancer patients. We recognize the need to establish clinical guidelines or recommendations for PS in Korea.
KEYWORD
Palliative Sedation, Refractory Symptoms, Terminal Cancer, Hospices
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