Complex Palliative Sedation at Home for Advanced Cancer Patients: A Daily Challenge to Identify Determinants

Hospital at Home (HaH) enables advanced cancer patients to receive end-of-life care in their preferred setting, yet evidence on home-based palliative sedation (PS) remains limited. This retrospective observational study included 113 patients who died in 2022 under the HaH Unit of the Instituto Valenciano de Oncología (Valencia, Spain). Sociodemographic, clinical, and PS-related variables were extracted from medical records. PS was required in 80 patients (70.8%). The median age was 76 years (IQR 19), 52.2% were male, and 77% lived in their own homes. Dyspnoea (43.7%) and delirium (23.7%) were the most frequent refractory symptoms leading to PS. Elastomeric infusers were used in 92.5% of cases. The median duration of PS was 1 day (IQR 2); 46.3% of patients died within 24 hours of initiation. A significant inverse correlation was found between the Barthel Index and PS duration (Spearman’s Rho = −0.226, p = 0.044), indicating shorter survival after sedation in patients with greater functional dependence. No significant associations were observed between PS requirement and multimorbidity, geriatric syndromes, polypharmacy, or prior opioid use. These findings support the feasibility of complex PS at home and highlight functional status as a potential determinant of PS duration, informing protocol optimization for home-based end-of-life care.