{
  "abstract": "Background: Advanced cancer patients may experience refractory suffering at the end of life despite optimal symptom management. When symptoms can no longer be controlled, or not within an acceptable timeframe, palliative sedation may be indicated. However, evidence on symptom severity and pharmacological strategies before sedation remains limited. This study aimed to characterize symptom burden and medication use in the 24 h before and after initiation of palliative sedation.\n\nMethods: In this prospective observational study, data were collected from adult cancer patients receiving palliative sedation at seven European care settings (hospital wards, hospices, and PCUs). Healthcare professionals documented symptoms, pharmacological management, and sedation characteristics. Symptom prevalence and severity was assessed by patients or proxies using the Edmonton Symptom Assessment System (ESAS).\n\nResults: Among 80 patients with palliative sedation, multiple refractory symptoms were common at initiation; 81% had two or more symptoms. Dyspnoea (23%), delirium (18%), and exhaustion (16%) were the primary symptoms prompting sedation. ESAS data (n = 66) showed high prevalence of drowsiness, appetite loss, tiredness, and reduced wellbeing (73–91%), with severe burden scores (≥ 7) in 63–78%. Prior palliative sedation, patients with fewer symptoms (1–2) received a wider range of medications, including corticosteroids, cardiovascular agents, and anti-infectives, while those with ≥ 3 symptoms more often received anxiolytics, hypnotics, and sedatives. After initiation, most medications were discontinued; opioids were continued, and midazolam was the predominant continuously administered sedative.\n\nConclusion: Refractory suffering often reflected overall clinical decline rather than isolated symptoms. While pre-sedation medication use varied, post-initiation strategies were consistent across patients.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00520-026-11358-7.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6500 HB The Netherlands",
    "Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands",
    "Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands",
    "ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain",
    "IdISNA‑Instituto de Investigación Sanitaria de Navarra, Palliative Medicine, Pamplona, Spain",
    "Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany",
    "Main Regional Centre of Supportive/Palliative Care, La Maddalena Cancer Centre, Palermo, Italy",
    "Symptom Control and Palliative Medicine, Clinica Universidad de Navarra, Pamplona, Spain",
    "Department of Oncology, Laboratory of Experimental Radiotherapy, University Hospital and Catholic University, Louvain, Belgium"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Maaike Rijpstra",
      "orcid": "0000-0002-8747-3833"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Evelien Kuip",
      "orcid": "0000-0002-9114-643X"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Alazne Belar",
      "orcid": "0000-0002-4831-5218"
    },
    {
      "affs": [
        5
      ],
      "name": "Séverine Marie Surges",
      "orcid": "0000-0001-6991-1767"
    },
    {
      "affs": [
        6
      ],
      "name": "Claudio Adile",
      "orcid": "0000-0002-0664-3520"
    },
    {
      "affs": [
        4,
        7
      ],
      "name": "Rocío Rojí",
      "orcid": "0000-0002-4444-1743"
    },
    {
      "affs": [
        6
      ],
      "name": "Sebastiano Mercadante",
      "orcid": "0000-0002-2060-0420"
    },
    {
      "affs": [
        5
      ],
      "name": "Lukas Radbruch",
      "orcid": "0000-0001-9526-396X"
    },
    {
      "affs": [
        8
      ],
      "name": "Johan Menten",
      "orcid": "0000-0003-2805-1953"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Carlos Centeno",
      "orcid": "0000-0003-3395-7039"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jeroen Hasselaar",
      "orcid": "0000-0002-8880-2029"
    },
    {
      "affs": [
        0
      ],
      "name": "Kris Vissers",
      "orcid": "0000-0002-2919-6356"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7thb3nv31mz78.bib",
  "cited_by": 0,
  "doi": "10.1007/s00520-026-11358-7",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13714141/",
  "id": "7thb3nv31mz78",
  "issns": [
    "0941-4355",
    "1433-7339"
  ],
  "landing_url": "https://doi.org/10.1007/s00520-026-11358-7",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2739|Palliative Care and End-of-Life Issues"
    ]
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  "openalex": "W7223986622",
  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s00520-026-11358-7.pdf",
  "pmcid": "PMC13714141",
  "pmid": "42944825",
  "published": "2026-10-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7thb3nv31mz78.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:21:41Z",
      "native_id": "PMC13714141",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s00520-026-11358-7"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Palliative Care and End-of-Life Issues",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Symptom burden profiles and applied medication strategies in the days before and after initiation of palliative sedation in advanced cancer patients: an international prospective multicentre observational study (PALSED)",
  "title_text": "Symptom burden profiles and applied medication strategies in the days before and after initiation of palliative sedation in advanced cancer patients: an international prospective multicentre observational study (PALSED)",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:41Z",
  "url": "https://research.draconitic.com/paper/7thb3nv31mz78",
  "venue": "Supportive Care in Cancer",
  "versions": []
}