Evidence map›Paper›PMID 26610854›Full record

ArticleThe Lancet. Oncology2016

Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study.

Isseki Maeda, Tatsuya Morita, Takuhiro Yamaguchi, Satoshi Inoue, Masayuki Ikenaga, Yoshihisa Matsumoto, Ryuichi Sekine, Takashi Yamaguchi, Takeshi Hirohashi, Tsukasa Tajima and 11 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in The Lancet. Oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 2 pooled it
8.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 105 citations in OpenAlex.

  1. Pooled it
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  11. [New recommendations on palliative sedation].Schmerz (Berlin, Germany) · 2024
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  13. Observational
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  18. The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022
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  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 16 institutions in 1 country.

Isseki MaedaDepartment of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: maeda@pm.med.osaka-u.ac.jp.
Tatsuya MoritaDepartment of Palliative and Supportive Care, Palliative Care Team, Kita-ku, Hamamatsu, Shizuoka, Japan; Seirei Hospice, Seirei Mikatahara General Hospital, Kita-ku, Hamamatsu, Shizuoka, Japan.
Takuhiro YamaguchiDivision of Biostatistics, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan.
Satoshi InoueSeirei Hospice, Seirei Mikatahara General Hospital, Kita-ku, Hamamatsu, Shizuoka, Japan.
Masayuki IkenagaChildren's Hospice Hospital, Yodogawa Christian Hospital, Higashiyodogawa-ku, Osaka, Japan.
Yoshihisa MatsumotoDepartment of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Ryuichi SekineDepartment of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan.
Takashi YamaguchiDepartment of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Takeshi HirohashiDepartment of Palliative Care, Mitui Memorial Hospital, Chiyoda-ku, Tokyo, Japan.
Tsukasa TajimaDepartment of Palliative Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan.
Ryohei TataraDepartment of Palliative Medicine, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan.
Hiroaki WatanabeKomaki City Hospital, Komaki, Aichi, Japan.
Hiroyuki OtaniDepartment of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
Chizuko TakigawaDepartment of Palliative Care, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan.
Yoshinobu MatsudaDepartment of Psychosomatic Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan.
Hiroka NagaokaDepartment of Medical Social Service Center for Palliative Care, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Masanori MoriSeirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Yo TeiSeirei Hospice, Seirei Mikatahara General Hospital, Kita-ku, Hamamatsu, Shizuoka, Japan.
Ayako KikuchiDepartment of Oncology, Mitsubishi Kyoto Hospital, Nishikyoku, Kyoto, Japan.
Mika BabaPalliative Care Division, Saito Yukoukai Hospital, Ibaraki, Osaka, Japan.
Hiroya KinoshitaDepartment of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Seirei Mikatabara General Hospital · JPKobe University · JPNational Cancer Center Hospital East · JPKameda Medical Center · JPKomaki City Hospital · JPMitsubishi Kyoto Hospital · JPMitsui Memorial Hospital · JPNational Hospital Organization Kyushu Cancer Center · JPNational Kinki Chuo Hospital for Chest Disease · JPNTT Medical Center · JPOsaka City General Hospital · JPOsaka University · JPSeirei Hamamatsu General Hospital · JPTohoku University Hospital · JPUniversity of Tsukuba · JPYodogawa Christian Hospital · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundContinuous deep sedation (CDS) before death is a form of palliative sedation therapy that has become a focus of strong debate, especially with respect to whether it shortens survival. We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival.

methodsThis study was a secondary analysis of a large multicentre prospective cohort study that recruited and followed up patients between Sept 3, 2012, and April 30, 2014, from 58 palliative care institutions across Japan, including hospital palliative care settings, inpatient palliative care units, and home-based palliative care services. Adult patients (aged ≥ 20 years) with advanced cancer who received care through the participating palliative care services were eligible for this secondary analysis. Patients with missing data for outcome variables or who lived for more than 180 days were excluded. We compared survival after enrolment between patients who did and did not receive CDS. We used a propensity score-weighting method to control for patient characteristics, disease status, and symptom burden at enrolment.

findingsOf 2426 enrolled patients with advanced cancer, we excluded 289 (12%) for living longer than 180 days and 310 (13%) with missing data, leaving an analysis population of 1827 patients. 269 (15%) of 1827 patients received CDS. Unweighted median survival was 27 days (95% CI 22-30) in the CDS group and 26 days (24-27) in the no CDS group (median difference -1 day [95% CI -5 to 4]; HR 0·92 [95% CI 0·81-1·05]; log-rank p=0·20). After propensity-score weighting, these values were 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1·01 [95% CI 0·87-1·17]; log-rank p=0·91). Age (p(interaction)=0·67), sex (p(interaction)=0·26), performance status (p(interaction)=0·90), and volume of artificial hydration (p(interaction)=0·14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (p(interaction)=0·021).

interpretationCDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialised palliative care services, and could be considered a viable option for palliative care in this setting.

fundingJapanese National Cancer Center Research and Development Fund.

Indexed as

Deep SedationAgedAged, 80 and overFemaleFluid TherapyHome Care ServicesHospicesHospitalsHumansJapanMaleMiddle AgedNeoplasmsPalliative CarePropensity ScoreProspective Studies

Identifiers

PMID26610854
OpenAlexW2180985086

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.