Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
J Palliat Med. 2023 Jan;26(1):79-86. doi: 10.1089/jpm.2021.0650. Epub 2022 Aug 9.
Palliative sedation therapy (PST) can address suffering at the end of life (EOL) in children with cancer; yet, little is known about PST in this population. We sought to describe the characteristics of pediatric oncology patients requiring PST at the EOL. A retrospective review was completed for pediatric oncology patients who required PST at a United States academic institution over 10 years, including demographics, disease characteristics, EOL characteristics, and medications for PST and symptom management. PST was utilized in 3% of patients at the EOL. Of 24 study participants receiving PST, 83% ( = 20), 12.5% ( = 3), and 4.2% ( = 1) received dexmedetomidine, propofol, or both, respectively. The most frequent diagnosis for patients receiving PST was acute myelogenous leukemia (20.8%, = 5). All patients were followed up by the palliative care team, and two-thirds (66.6%, = 16) were also followed up by the pain management service; 79% ( = 19) were enrolled in hospice, and 98.5% ( = 23) had a Physician Orders for Scope of Treatment in place. Pain was the most common refractory symptom leading to PST initiation (33.3%, = 8), followed by neuroagitation and dyspnea. PST was initiated a median of 2.5 days before death. A third of deaths occurred in the intensive care unit (33.3%, = 8). PST was rare in this study; dexmedetomidine was used as first-line treatment for PST in patients at the EOL with refractory symptoms. Its place in PST protocols in pediatric oncology should be validated with prospective studies. Our study suggests the potential value of collaboration between palliative care and pain specialists in the context of PST.
姑息镇静治疗（PST）可以解决癌症患儿生命末期（EOL）的痛苦；然而，人们对这一人群中的 PST 知之甚少。我们旨在描述需要在 EOL 进行 PST 的儿科肿瘤患者的特征。对美国一家学术机构在 10 年内需要 PST 的儿科肿瘤患者进行了回顾性研究，包括人口统计学、疾病特征、EOL 特征以及 PST 和症状管理的药物。PST 在 EOL 患者中的使用率为 3%。在接受 PST 的 24 名研究参与者中，83%（ = 20）、12.5%（ = 3）和 4.2%（ = 1）分别接受了右美托咪定、异丙酚或两者的联合治疗。接受 PST 的患者最常见的诊断是急性髓细胞性白血病（20.8%， = 5）。所有患者均由姑息治疗团队随访，三分之二（66.6%， = 16）也由疼痛管理服务随访；79%（ = 19）参加了临终关怀，98.5%（ = 23）有医生制定的治疗范围医嘱。疼痛是导致 PST 开始的最常见难治性症状（33.3%， = 8），其次是神经激越和呼吸困难。PST 的开始时间中位数为死亡前 2.5 天。三分之一的死亡发生在重症监护病房（33.3%， = 8）。在这项研究中，PST 很少见；右美托咪定被用作 EOL 伴有难治性症状的 PST 患者的一线治疗药物。前瞻性研究应验证其在儿科肿瘤 PST 方案中的地位。我们的研究表明，姑息治疗和疼痛专家在 PST 背景下合作具有潜在价值。
