RT Journal Article
SR Electronic
T1 Palliative sedation in paediatric solid tumour patients: choosing the best drugs
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP e1141
OP e1148
DO 10.1136/bmjspcare-2022-003534
VO 13
IS e3
A1 Podda, Marta Giorgia
A1 Schiavello, Elisabetta
A1 Nigro, Olga
A1 Clerici, Carlo Alfredo
A1 Simonetti, Fabio
A1 Luksch, Roberto
A1 Terenziani, Monica
A1 Ferrari, Andrea
A1 Casanova, Michela
A1 Spreafico, Filippo
A1 Meazza, Cristina
A1 Chiaravalli, Stefano
A1 Biassoni, Veronica
A1 Gattuso, Giovanna
A1 Puma, Nadia
A1 Bergamaschi, Luca
A1 Sironi, Givanna
A1 Massimino, Maura
YR 2023
UL http://spcare.bmj.com/content/13/e3/e1141.abstract
AB 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.No data are available.