Drug therapy for anxiety in palliative care

Jackson KC, Lipman AG

Published Online:

October 7, 2009

Currently there is no evidence on the role of drugs in the treatment of anxiety associated with terminal illness. Anxiety is a common symptom associated with patients near the end of life. As with other areas of palliative care, the majority of available literature pertaining to drug therapy for anxiety in terminal illness is anecdotal. A search of the international literature for randomised clinical trials in the area of drug therapy for anxiety in palliative care yielded no results. As a consequence, it is not possible to assess the effectiveness of treatment options. It is hoped that this review will motivate future research into this area.

Abstract (click to read)

Background:

Anxiety is common among patients with advanced disease. It can be a natural response to impending death, but may also result from an underlying anxiety disorder, pain, or other untreated or poorly managed symptoms.

Objectives:

The primary objective of this review was to identify and evaluate studies examining medications used to treat patients suffering from anxiety during the terminal phases of disease.

Search strategy:

We searched the following sources: MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003) , CINAHL (1982 to July 2003), PsycLit (1974 to July 2003), PsycInfo (1990 to July 2003), and The Cochrane Library (Issue 2, 2003) for literature pertaining to this topic published in any language using a detailed search strategy.

Selection criteria:

Prospective, randomized trials with or without blinding involving the use of pharmacological agents for the treatment of anxiety at the end of life were sought.

Data collection and analysis:

Six potential studies were identified by the search strategy but none met the criteria for inclusion in this review. Two of these studies assessed the effectiveness of alprazolam in patients with a diagnosis of cancer, but who would not be considered in the end-stage of life.

Main results:

No data were available to enable an assessment to be made of the effectiveness of drugs to treat anxiety in palliative care patients.

Authors' conclusions:

There remains insufficient evidence to draw a conclusion about the effectiveness of pharmacotherapy for anxiety in terminally ill patients. To date no studies were found that met the inclusion criteria for this review. Prospective controlled clinical trials are necessary in order to establish the benefits and harms of pharmacotherapy for the treatment of anxiety in palliative care.

This record should be cited as:

Jackson KC, Lipman AG. Drug therapy for anxiety in adult palliative care patients. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004596. DOI: 10.1002/14651858.CD004596

Assessed as up to date:

October 8, 2003

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Cancer > Palliative and supportive care > Symptomatic relief

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Drug therapy for anxiety in palliative care

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