Current Use of Sedatives for Terminal Cancer Patients near Death Receiving Home Palliative Care, and Influence on Home Care Period

Objective: This study investigated the association between use of sedatives in terminal cancer patients near death who were receiving home care and the home care period. Methods: We conducted a retrospective review of the medical records for 1032 cancer patients who received home palliative care from 17 specialized home care clinics between June and November 2013. We checked the use of sedatives within 48 hours before death at home, and we compared the home care period between patients with and without sedation. Results: The sedatives used were diazepam (n, %: 100, 52%), flunitrazepam (29, 15%), bromazepam (27, 14%), midazolam (26, 13%), and phenobarbital (20, 10%). The median home care period (median [quartiles]) was 26 [13, 63] days and 25 [10, 64] days (Adj p=0.79) for the patients with and without sedatives, respectively. Conclusion: Among terminal cancer patients near death receiving home care, 24% were administered sedatives, with more than half of those patients receiving diazepam. There was no association between use of sedatives and the home care period.

Are specialized home care clinics and the Doctor net exclusive to each other?

The purpose of the present study was to obtain the insights about the roles of specialized home care clinics and the “Doctor net” in community palliative care by investigating changes in the home death rates of cancer patients in a city where both specialized home care clinics and the Doctor net are available. A region palliative care intervention study was conducted, and data on the rate of cancer patients who died at home between 2007 and 2010 in the region were collected. The rate of cancer patients who died at home increased from 7.0% in 2007 to 13.0% in 2010. In 2007, 49% of the total number of people who died at home were patients of specialized home care clinics, and the rate increased to 13.0% in 2010. However, the number of cancer patients of other clinics who died at home did not decrease, from 63 in 2007 to 98 in 2009 and 77 in 2010. The functions of specialized home care clinics and the Doctor net adopted in general clinics were not exclusive to each other, and specialized home care clinics may improve palliative care implemented for cancer patients at home by participating in the Doctor net to provide general clinics with support.