Clinical profile and challenges of midazolam-based palliative sedation for terminal cancer patients: A retrospective observational study from a tertiary medical center in mainland China.

BACKGROUND

Palliative sedation is a key component of palliative care for end-stage cancer patients with refractory symptoms. In mainland China, midazolam-based titrated palliative sedation is rarely used clinically, with limited data and studies reported.

AIM: To illustrate the development of clinical practice patterns for midazolam-based palliative sedation in advanced cancer patients in mainland China, identify clinical regularities, and summarize clinical experience to promote the administration of palliative sedation for terminally ill cancer patients in mainland China.

DESIGN

A retrospective observational study was conducted using clinical records of terminal cancer patients who underwent midazolam-based palliative sedation from 2016 to 2025.

SETTING/

PARTICIPANTS

Terminal cancer patients who underwent palliative sedation in the oncology ward of Hangzhou Hospital of Traditional Chinese Medicine, a tertiary medical center in Eastern mainland China.

RESULTS

The overall implementation rate of palliative sedation in terminal cancer patients was 7.98% (55/689). Refractory dyspnea was the primary indication for sedation (47.3%). The proportion of patients receiving adequate sedation was significantly higher in the titrated group than in the non-titrated group (p < 0.001). The mean survival time of the 50 patients who received adequate sedation was 67.45 h. Among them, the mean survival time in the dyspnea subgroup (38.88 h) was significantly shorter than in the pain (125.42 h) and agitation (120.33 h) subgroups (p < 0.001). The mediation analysis further demonstrated that the indication for palliative sedation (presence or absence of dyspnea) fully mediated the association between the patient's disease diagnosis (presence or absence of lung cancer) and survival time. In this study, 66.7% of family members had never previously heard of palliative sedation, and their attitudes toward this therapy were quite ambivalent.

CONCLUSION

Effective communication of palliative sedation helps improve family members' acceptance of this therapy. Patients with refractory dyspnea, especially lung cancer patients with this symptom (who may have more severe underlying disease), may have shorter survival times than those with agitation or pain. Rigorous pre-procedural risk communication with families is recommended before sedation, and close monitoring and assessment during sedation are essential for safety.