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  P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27726

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    P3.15-20 - Palliative Sedation in Lung Cancer Patients Whom Needs Immediate or Elective Intractable Symptom Control   (ID 13403)

    12:00 - 13:30  |  Author(s): Ali Ayberk Besen
    • Abstract

    Background
    

    Advanced cancer patients frequently experience high-distressing symptoms which could not be relieved with standard oncological treatment even can be refractory to intensive palliative care. For these cases, palliative sedation or decrease patient’s consciousness below certain level (ramsay score 4 or more) is well defined but not well standardized procedure for intractable symptoms of cancer patients.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    The patients included into this study in consecutive way without any exception from November 2014 to August 2017. There were 82 patients (90.0%) and 9 patients (10.0%) with NSCLC and SCLC, respectively. Palliative sedation protocol is consisted of midazolam /morphine (30 mg/24 hr). For the effectiveness of the palliative sedation, we accept taregt RSS score of 4 for the immediate and elective patients.

    4c3880bb027f159e801041b1021e88e8 Result
    

    There were 62 and 29 patients electively or urgently sedated. Median age of patients in elective and immediate sedation were 61.5 and 63, respectively.

    Additionally, main etiologies for the refractory symptoms were dyspnea, delirium and intractable pain in 44 (71.0%) vs 3 (4.8%), 15 (24.2%) vs 16 (55.2%), and 6 (20.7%) vs 7 (24.1) patients for the elective and immediate sedation groups. There was no statistically significant difference between two groups with regard to sex, age and main reasons for the palliative sedation. Duration of palliative sedation were 0.59 days in immediate group whereas this time significantly longer in elective group with 4.7 days (p<0.01). Time between last chemotherapy and start of the palliative sedation were 82.3 vs 119.0 days in elective and immediate group, respectively. In elective sedation group, target score of R4 was achieved in 32 (51.6%) patients whereas in immediate sedation group score of R4 was significantly lower than elective group and achieved in only 3 (10.3%) patients, respectively (p<0.01). Dose of 30-30 mg/24-hour IV MaM infusion was perfectly enough for the immediate sedation group , 60-60 mg and 90-90 MaM infusions were required in 10 (16.1%) and 5 (8.1%) patients for target RS. Adverse events were seen in 18 (29%) and 7 (24.1%) patients in elective and immediate group, respectively. Hypotension was the most prominent adverse event in both groups.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Palliative sedation is effective way of controlling intractable symptoms. Most common reason for palliative sedation was progressive dyspnea in lung cancer for both groups. 30-30 mg/24-hour IV MaM starting dose well tolerated and highly effective dose, 15/15 mg dose increment can be done if needed.

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