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)
9 affiliations
- 1Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6500 HB The Netherlands
- 2Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- 3Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
- 4ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- 5IdISNA‑Instituto de Investigación Sanitaria de Navarra, Palliative Medicine, Pamplona, Spain
- 6Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- 7Main Regional Centre of Supportive/Palliative Care, La Maddalena Cancer Centre, Palermo, Italy
- 8Symptom Control and Palliative Medicine, Clinica Universidad de Navarra, Pamplona, Spain
- 9Department of Oncology, Laboratory of Experimental Radiotherapy, University Hospital and Catholic University, Louvain, Belgium
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.
Methods: 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).
Results: 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.
Conclusion: Refractory suffering often reflected overall clinical decline rather than isolated symptoms. While pre-sedation medication use varied, post-initiation strategies were consistent across patients.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00520-026-11358-7.
Related
- Antiseizure medication-induced changes in serum ephrin-B2 and their association with treatment response in adults with generalised seizure disorders in Northern India: protocol for a prospective observational cohort study
- Epidemiology and outcome of sudden cardiac arrest in elderly Nigerians: a prospective multicentre observational survey
- Regional anaesthesia in Video or Robot assisted thoracic surgery: A French multicentre prospective observational cohort study (ARTIST study)
- Interstitial Lung Diseases treatment prescription practices among pulmonologists in India: A prospective multicentre observational study (India-ILD care study).
- Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study
BibTeX
@article{rijpstra2026symptom,
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)}},
author = {Maaike Rijpstra and Evelien Kuip and Alazne Belar and Séverine Marie Surges and Claudio Adile and Rocío Rojí and Sebastiano Mercadante and Lukas Radbruch and Johan Menten and Carlos Centeno and Jeroen Hasselaar and Kris Vissers},
journal = {Supportive Care in Cancer},
year = {2026},
month = oct,
doi = {10.1007/s00520-026-11358-7},
url = {https://doi.org/10.1007/s00520-026-11358-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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)
AU - Maaike Rijpstra
AU - Evelien Kuip
AU - Alazne Belar
AU - Séverine Marie Surges
AU - Claudio Adile
AU - Rocío Rojí
AU - Sebastiano Mercadante
AU - Lukas Radbruch
AU - Johan Menten
AU - Carlos Centeno
AU - Jeroen Hasselaar
AU - Kris Vissers
PY - 2026
DA - 2026/10/27
JO - Supportive Care in Cancer
DO - 10.1007/s00520-026-11358-7
UR - https://doi.org/10.1007/s00520-026-11358-7
AB - 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. Methods: 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). Results: 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. Conclusion: Refractory suffering often reflected overall clinical decline rather than isolated symptoms. While pre-sedation medication use varied, post-initiation strategies were consistent across patients. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00520-026-11358-7.
SN - 0941-4355
SN - 1433-7339
ER -