Background: Palliative sedation is defined as monitored use of medication intended to induce a state of decreased or absent awareness to relieve intractable suffering in a manner that is ethically acceptable to the patient, family, and health-care providers. The prevalence of palliative sedation reported ranges from 10% to 50% during in end of life care setting. There was no major review performed on the prevalence and practice of palliative sedation in Hong Kong. Besides, published guidelines and medication recommendations are developed in Caucasian settings, which may not be taken into account the cultural aspect in Chinese. Therefore, we would like to review our practice in caring terminal cancer patients to report the prevalence and practice of palliative sedation and to review factors associated with successful sedation in this group of patients. Methods: One-hundred and eighty consecutive patients with histological or radiological evidence of malignancy who died in palliative care ward from 1st July to 30th September 2017 were screened. All patients who received continuous midazolam infusion were included. Patients’ demographic data, cancer disease status, laboratory results and interview records were retrieved from electronic patient records and in-patient hospital notes. The reason for sedation, background and concurrent symptoms during sedation, and the clinical notes on symptom control during the sedation period were all reviewed. All the drug records including the dose of midazolam and other concomitant drugs, duration of palliative sedation as well as the depth of sedation were assessed. Survival data estimated from the day of admission to our department until death were recorded. Results: Three hundred and thirty-nine patient-days, contributed by 81 patients out of 180 patients (45%), with midazolam infusion were studied. There was no statistical difference in the baseline characteristics of both patient groups. Median survival since admission to oncology ward in the sedated group was 11 versus 9 days in the non-sedated group (P=0.65). The median time for patients on sedation was 32.33 hours (range, 2.91–1,240 hours). Dyspnea was the most common cause of palliative sedation (78.0%), followed by delirium (40.9%). The mean dose of midazolam infusion was 10 milligram per day (range, 5–45 mg). Deranged liver function was the only statistically significant factor associated with successful sedation after multivariate analysis. Conclusions: The use of palliative sedation is safe and effective in managing refractory symptoms and is not associated with worsening of survival. Deranged liver function was associated with better symptom control. The dose of midazolam and haloperidol needed for adequate symptom control were lower than suggested in Western guidelines. Further studies on the dose requirement in Chinese population are warranted. Establishing consensus and guidelines on palliative sedation in Hong Kong should be the way forward to ensure quality care to this group of patients.

Background: Lenvatinib is an established first-line therapy for radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC); however, real-world data, particularly from Asian populations with long-term follow-up, remain limited. Methods: We conducted a multicentre retrospective cohort study across seven public hospitals in Hong Kong. Adult patients with RAI-refractory DTC who received lenvatinib between 1 January 2010 and 31 March 2025 were included. Efficacy outcomes included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and duration of treatment. Landmark analyses were performed at 6 and 12 months after lenvatinib initiation. Safety outcomes included treatment-related adverse events graded according to CTCAE version 5.0. Results: A total of 82 patients were included, with a median follow-up of 24.7 (IQR, 14.2–46.6) months. The median age at treatment initiation was 69 years, and the median starting dose of lenvatinib was 14 mg. Median PFS was 31.0 months (95% CI, 16.6–40.8) and median OS was 46.8 months (95% CI, 33.6–67.6), with multivariable analyses identifying brain metastasis as the most consistent adverse prognostic factor. The ORR was 52.4% and the DCR was 82.9%. Treatment-related adverse events were common, most frequently hypertension (73.2%) and proteinuria (57.3%); grade ≥ 3 events occurred predominantly as hypertension (45.1%). Conclusions: Lenvatinib achieved durable clinical outcomes in patients with RAI-refractory differentiated thyroid cancer despite the frequent use of reduced starting doses. Treatment-related toxicities were common but generally manageable, allowing prolonged treatment in many patients.