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Palliative sedation in paediatric solid tumour patients: choosing the best drugs
  1. Marta Giorgia Podda1,
  2. Elisabetta Schiavello1,
  3. Olga Nigro1,
  4. Carlo Alfredo Clerici2,3,
  5. Fabio Simonetti1,
  6. Roberto Luksch1,
  7. Monica Terenziani1,
  8. Andrea Ferrari1,
  9. Michela Casanova1,
  10. Filippo Spreafico1,
  11. Cristina Meazza1,
  12. Stefano Chiaravalli1,
  13. Veronica Biassoni1,
  14. Giovanna Gattuso1,
  15. Nadia Puma1,
  16. Luca Bergamaschi1,
  17. Givanna Sironi1 and
  18. Maura Massimino1
  1. 1Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  2. 2Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  3. 3Department of Oncology and Hematology, Università degli Studi di Milano, Milano, Italy
  1. Correspondence to Dr Marta Giorgia Podda, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano 20133, Italy; marta.podda{at}istitutotumori.mi.it

Abstract

Objectives Cancer remains the leading cause of mortality by disease in childhood in high-income countries. For terminally ill children, care focuses on quality of life, and patient management fundamentally affects grieving families. This paper describes our experience of palliative sedation (PS) for children with refractory symptoms caused by solid tumours, focusing on the drugs involved.

Methods We retrospectively collected data on all children treated for cancer who died at the pediatric oncology unit of the Fondazione IRCCS Istituto Nazionale dei Tumori between January 2016 and December 2020.

Results Of the 29 patients eligible for the study, all but 4 received PS. Midazolam was always used, combined in 16 cases with other drugs (mainly classic neuroleptics, alpha-2 agonists and antihistamines). Throughout the period of PS and on the day of death, patients with sarcoma were given higher doses of midazolam and morphine, and more often received combinations of drugs than patients with brain tumours. Sarcoma causes significant symptoms, while brain tumours require less intensive analgesic-sedative therapies because they already impair a patient’s state of consciousness.

Conclusions Optimising pharmacological treatments demands a medical team that knows how drugs (often developed for other indications) work. Emotional and relational aspects are important too, and any action to lower a patient’s consciousness should be explained to the family and justified. Parents should not feel like helpless witnesses. Guidelines on PS in paediatrics could help, providing they acknowledge that a child’s death is always a unique case.

  • End of life care
  • Terminal care
  • Paediatrics
  • Drug administration

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Contributors MGP, ES, FS and GG have contributed to the conception or design of the study. MGP, NP, LB, VB, ON, GS and MC have contributed to data interpretation. MGP drafted the manuscript. MGP, SC, MC and AF were involved in critical revision of the manuscript. All authors gave their final approval of the version to be published. MGP is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.