Symptom Control during the Last Week of Life on a Palliative Care Unit

A recent report suggested that more than 50 % of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. Of the 100 patients, 99 had pain, 46 had dyspnea, 71 had nausea, and 39 experienced delirium. Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31±24 on Day 6 to 24±19 on day of death (DOD) (p<0.05); nausea from 19±18 on Day 6 to 13±9 on DOD (p<0.01); drowsiness from 51±28 on Day 6 to 85±45 on DOD (p<0.001); symptom distress score from 49±11 on Day 6 to 52±9 on DOD (p<0.01). On the day of admission (DOA), 69 % of VAS were done by the patient and 28 % by the nurse as compared to 8 % by the patient and 90 % by the nurse on DOD. Level of consciousness on DOA was alert (72 %), drowsy (28 %), unresponsive (0 %) and by DOD was alert (2 %), drowsy (41%), unresponsive (57%). Symptom control on DOA was evaluated as good (64%), fair (26 %), poor (10 %) and by DOD was good (84 %), fair (14 %), poor (2 %). Evaluation of patient records and medication changes revealed 6/99 patients with pain (6 %) and 10/39 patients with delirium (26 %) requiring increased treatment, probably resulting in sedation in the last days of life. Thus, only 16 of 100 patients (16 %) required treatment for pain and delirium that would have caused sedation in order to achieve symptom relief.