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Palliative sedation and time to death in home palliative care: retrospective analysis
  1. Daniele Marinelli1,
  2. Giulio Ravoni2,
  3. Maria Fusilli2,
  4. Emilia Colpani2,
  5. Marco Filetti1,3,
  6. Daniele Santini4,
  7. Giampiero Porzio2 and
  8. Raffaele Giusti5
  1. 1Department of Experimental Medicine, Sapienza University, Rome, Italy
  2. 2Home Care Service, Associazione Tumori Toscana, Firenze, Italy
  3. 3UOC Phase I, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  4. 4Department of Medical-Surgical Sciences and Biotechnologies, Università degli Studi di Roma La Sapienza, Rome, Italy
  5. 5Medical Oncology Unit, Sant'Andrea Hospital, Rome, Italy
  1. Correspondence to Dr Daniele Marinelli, Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy; danielemarinelli1{at}


Objectives We described time to death and rates of palliative sedation during home palliative care leveraging a retrospective cohort of patients with advanced cancer.

Methods The cohort consists of 143 patients with solid or haematological malignancies admitted to home palliative care in the Tuscany region in central Italy. Only patients for whom a date of death was available were included. The outcome measures were time from admission to home palliative care to death and receipt of palliative sedation.

Results 143 patients were included in this report. Lower Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores were significantly associated with anticancer treatment at admission, as was younger age. Increasing ECOG PS scores were associated with lower survival time. Women and patients on anticancer treatment had longer survival time. Thirty-eight per cent of patients underwent palliative sedation at home; palliative sedation was more frequent among younger patients and among patients with brain or lung cancer. The most common reasons for palliative sedation were delirium and dyspnoea.

Conclusions ECOG PS, sex and anticancer treatment had a significant impact on survival time. Thirty-eight per cent of patients in our cohort underwent home palliative sedation for refractory symptoms, most often delirium and dyspnoea.

  • Home care
  • Cancer
  • Symptoms and symptom management
  • Terminal care

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  • Contributors Conceptualisation: GR, MFu, EC, MFi, GP and RG. Methodology and writing (review and editing): DM, DS, GP and RG. Software, formal analysis and writing (original draft): DM. Data curation: DM, GR, MaFu and EC. Supervision: RG.

  • 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; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.