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Rapid discontinuation of hypnotics in terminal cancer patients: a prospective study
E Bruera1, R L Fainsinger, T Schoeller
1Palliative Care Program, Edmonton General (Grey Nuns Community Health Centre), University of Alberta, Canada.
Purpose:
To determine the proportion of patients receiving hypnotics upon admission to a palliative care unit, the frequency and intensity of withdrawal symptoms after rapid hypnotic discontinuation, and the effect of discontinuation on insomnia and cognitive failure.
Patients And Methods:
120 consecutive admitted patients. Rapid hypnotic discontinuation (1-4 days) was attempted. Insomnia (visual analogue 0 = best, 100 = worst for insomnia, restedness during the morning and difficulty falling asleep), cognition (Mini-Mental State Questionnaire), and withdrawal signs were monitored.
Results:
Upon admission, 92/120 patients (77%) had been receiving hypnotics for a mean of 11 (standard deviation = 8) weeks. 4/92 patients (4%) refused hypnotic discontinuation. Acute mild withdrawal was observed in 2/88 patients (2%). The intensity of insomnia was not significantly different, while cognition significantly improved after hypnotic discontinuation.
Conclusion:
A large proportion of terminal cancer patients receives hypnotic drugs chronically. These drugs are probably not useful for the treatment of their insomnia, and rapid discontinuation can be safely achieved in most patients.