Continuous sedation in adolescent and young adult cancer patients under home-based end-of-life care.

PURPOSE: This study examined the implementation status of continuous sedation (CS) and its clinical and social background factors in adolescent and young adult (AYA) patients with cancer who received end-of-life care at home.

METHODS

We conducted a single-center retrospective observational study with 62 AYA patients with cancer. We compared the CS (S) and non-sedation (NS) groups, analyzing factors contributing to sedation implementation.

RESULTS

CS implementation rate was 37.1% (23/62 cases). Participants' median age was 36 (S group) and 33 (NS group) years (p = 0.08). Both groups had similar median time from initial home consultation to death (30 vs. 34 days, resp., p = 0.6). Midazolam was the most frequently used sedative agent (82.6%), administered at a median of 20 mg/day. Delirium occurred significantly more frequently in the S (vs. NS) group (60.9% vs. 23.1%, p = 0.006). Primary indications for sedation were dyspnea (47.8%), pain (26.1%), and delirium (17.4%). The S (vs. NS) group had significantly higher morphine equivalent doses (median 120 vs. 60 mg, p = 0.0008) and higher rates of patient-controlled analgesia implementation (56.5% vs. 20.5%, p = 0.0056). Cases where spouses were primary decision-makers were more frequent in the S (vs. NS) group (60.9% vs. 30.8%, p = 0.033).

CONCLUSION

This descriptive analysis revealed lower CS rates among patients aged < 30 years. Sedation was not associated with shortened survival. Dyspnea was the most common sedation indication, with high-dose opioid use, delirium incidence, and spousal decision-making as primary factors associated with sedation administration. Given the small sample size and retrospective design, findings should be interpreted as exploratory.