Continuous Sedation in Palliative Care in Portugal: A Prospective Multicentric Study.

Objective: This study aimed to survey the practice of palliative sedation in Portugal, where data on this subject were lacking. Methods: This was a prospective multicentric study that included all patients admitted to each team that agreed to participate. Patients were followed until death, discharge, or after 3 months of follow-up. Results: The study included 8 teams: 4 as palliative care units (PCU), 1 as a hospital palliative care team (HPCT), 2 as home care (HC), and 1 as HPCT and HC. Of the 361 patients enrolled, 52% were male, the median age was 76 years, and 285 (79%) had cancer. Continuous sedation was undergone by 49 (14%) patients: 26 (53%) were male, and the median age was 76. Most patients, 46 (94%), had an oncological diagnosis. Only in a minority of cases, the family, 16 (33%), or the patient, 5 (10%), participated in the decision to sedate. Delirium was the most frequent symptom leading to sedation. The medication most used was midazolam (65%). In the multivariable analysis, only age and the combined score were independently associated with sedation; patients <76 years and those with higher levels of suffering had a higher probability of being sedated. Conclusions: The practice of continuous palliative sedation in Portugal is within the range reported in other studies. One particularly relevant point was the low participation of patients and their families in the decision-making process. Each team must have a deep discussion on this aspect.

A Palliative Care Approach to Amyotrophic Lateral Sclerosis.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a degenerative disease characterized by motor dysfunction. Currently, treatment options are limited and management is based mostly on symptom control and quality of life optimization, so palliative care plays a fundamental role. Our objective was to characterize the ALS population in Madeira Island that was referenced and/or followed by a palliative care unit over a five-year period. METHODS: Longitudinal, retrospective, descriptive, and observational study to analyze patients with ALS who were referred and/or followed by a palliative care unit during a five-year period, between 2017 and 2021. Patient's medical electronic and physical records were analyzed to gather data. Descriptive and inferential statistical analysis was done using Microsoft Excel and Statistical Package for the Social Sciences (version 28.0.1). RESULTS: During this five-year period, a total of 38 patients were diagnosed with ALS in Madeira Island and 23 (60.53%) were referred to palliative care. Three patients died before assessment, so 20 (50.63%) were followed by the palliative care team. They had a median life expectancy of 425 days and the median time spent in palliative care was 137 days. Of this population, 56.52% (n=13) was male with an average age of 64 years. The median period from diagnosis to referral was 167 days, with most referrals being made by family medicine (39.13%; n=9) motivated by uncontrolled symptoms (95.65%; n=22). The median period from referral to first assessment by a palliative care physician was 19 days. The Palliative Performance Scale (PPS) and Confusion Assessment Method (CAM) applied on the first visit had a median score of 40% in the former and was negative in 95.00% (n=19) of patients in the latter. Advanced care directives were present in 55.00% (n=11) of patients and all provided care was in accordance with the patient's wishes. The most common symptoms were dysphagia, dyspnea, pain, anxiety, and sialorrhea. The most used drugs were morphine, riluzole, butylscopolamine, bisacodyl, and midazolam. As for other interventions, 55.00% (n=11) of patients underwent noninvasive ventilation (NIV), 15.00% (n=3) were submitted to percutaneous endoscopic gastrostomy (PEG), and one patient (5.00%) was nasogastrically intubated. The death rate was 95.00% (n=19) with 73.68% (n=14) of deaths occurring in the palliative care unit. CONCLUSION: Literature has shown that there are many advantages to the early inclusion of palliative care in ALS management, achieving effective symptom control and greater quality of life, but also reducing caregiver burden. However, in this study, we found that referrals to palliative care were late and included mostly cases of advanced disease with uncontrolled symptoms.

Hyponatremia in Cancer Patients Hospitalized in a Palliative Care Department: A Cross-Sectional Analysis.

INTRODUCTION: Hyponatremia is frequent in cancer patients, as many studies carried out in these patients have shown. However, there are only a few studies carried out at the end of life and in palliative care. The aim of this study was to determine the prevalence of hyponatremia in cancer patients in the palliative care department of an oncology center and its association with survival. MATERIAL AND METHODS: The study included the first 300 patients hospitalized in the palliative care department in 2017. Survival was measured from the day of hospitalization until death. RESULTS: Serum sodium was measured in 170 (59%) patients. The median serum concentration was 135 mmol/L (109 to 145). Among 91 (54%) patients, serum sodium was within the normal range, 59 (35%) had mild hyponatremia, 13 (8%) had moderate and seven (4%) had profound hyponatremia. The median survival was 13 days (1 to 1020). Serum sodium was not significantly associated with survival (p = 0.463). Regarding other variables, the Eastern Cooperative Oncology Group performance status was significantly associated with survival, while gender, age, primary cancer and number of metastatic sites were not. DISCUSSION: Hyponatremia, mainly mild and moderate, was found in almost half of the patients included in this study. However, unlike other studies, hyponatremia was not associated with a poorer prognosis. CONCLUSION: Hyponatremia is common in cancer patients receiving palliative care but did not seem to influence survival.

Introdução: A hiponatremia é frequente em doentes com cancro, como muito estudos realizados nesses doentes mostraram. Contudo, há poucos estudos no fim da vida e em cuidados paliativos. O objectivo deste trabalho foi estudar a prevalência da hiponatremia em doentes oncológicos num serviço de cuidados paliativos de um centro oncológico e a sua associação com a sobrevivência. Material e Métodos: O estudo incluiu os primeiros 300 doentes internados no serviço de cuidados paliativos em 2017. A sobrevivência foi medida do dia da hospitalização até à morte. Resultados: O sódio plasmático foi medido em 170 (59%) doentes. A mediana da concentração de sódio plasmático foi 135 mmol/L (109 a 145). Em 91 (54%) doentes, o sódio plasmático estava dentro dos valores de referência, 59 (35%) tinham hiponatremia ligeira, em 13 (8%) era moderada e sete (4%) tinham hiponatremia profunda. A mediana da sobrevivência foi de 13 dias (1 a 1020). O sódio plasmático não apresentou uma associação estatisticamente significativamente associado com a sobrevivência (p = 0,463). Quanto a outras variáveis, o estado de performance do Eastern Cooperative Oncology Group associou-se significativamente à sobrevivência, o que não se verificou com o género, a idade, o tumor primário e o número de locais de metástases. Discussão: A hiponatremia, principalmente ligeira e moderada, ocorreu em quase metade dos doentes incluídos neste estudo. No entanto, ao contrário de outros estudos, a hiponatremia não se associou a um pior prognóstico. Conclusão: A hiponatremia é comum nos doentes oncológicos em cuidados paliativos, mas não parece influenciar a sobrevivência.