Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

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The aim of the present study was to evaluate the impact of palliative care on patients' symptoms, using the Edmonton Symptom Assessment System (ESAS) to measure symptom intensity at the time of admission and variations registered during the first 7 days' hospitalization. Three hundred fourteen patients were admitted to the unit during its first year of activity. Of these, 162 patients (51.6%) completed, 62 (19.7%) partially completed, and 90 (28.7%) did not complete the ESAS. The mean (+/-SD) value of the Symptom Distress Score (SDS) (sum of the values of the different symptoms) for the 162 evaluable patients on Day 1 was 33.93 (+/-16.24). On Day 7 the mean was 28.14 (+/-15.11) (ANOVA for repeated measurements, P < 0.0001). ESAS values for patients with moderate-severe symptom intensity (average values Day 1-Day 7 and P value, ANOVA for repeated measurements) were as follows: pain (7.12-4.23, P < 0.0001), fatigue (7.46-5.68, P < 0.0001), nausea (7.12-1.96, P < 0.0001), depression (7.26-5.28, P < 0.0001), anxiety (7.13-5.14, P < 0.0001), drowsiness (7.42-6.40, P = 0.002), anorexia (7.33-4.33, P < 0.0001), well-being (6.83-3.85, P < 0.0001), and dyspnea (7.08-3.86, P < 0.0001). These data seem to indicate that the patients who benefit most from inpatient palliative care are those with the most complex symptomatology.

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