Determinants of the sensation of thirst in terminally ill cancer patients

Abstract

While a sensation of thirst causes severe distress for a certain proportion of cancer patients in the terminal stage, the factors contributing to this symptom have not been established. To clarify the association between sensation of thirst and medical factors, especially dehydration, a cross-sectional observational study was performed on terminally ill cancer patients receiving inpatient hospice care. On admission to a palliative care unit, 88 consecutive patients underwent blood sampling and were requested to rate the intensity of thirst on a visual analogue scale (VAS). Physicians prospectively evaluated factors that might potentially be contributing to the symptom. The mean VAS score for thirst was 5.0+/-2.8, and 18% of the patients complained of severe thirst with a VAS score of > or = 8. No significant correlations were observed between the VAS score for thirst and the values of total protein, blood urea nitrogen (BUN), creatinine, sodium, osmolality, hematocrit, atrial natriuretic peptide (ANP), and biochemical dehydration defined by the levels of BUN, creatinine, sodium and osmolality. On the other hand, dehydration defined by ANP level (< or = 15 pg/ml), hyperosmolality (> or = 300 mosmol/kg), gastrointestinal cancer, survival, performance status, oral intake, vomiting, and stomatitis were significantly associated with the severity of thirst. In addition, mouth breathing and opioids were determined to be a potential clinical cause of severe thirst when a retrospective chart review was carried out. In conclusion, sensation of thirst is a frequent symptom in terminally ill cancer patients and is associated with dehydration, hyperosmolality, poor general conditions, stomatitis, oral breathing, and opioids. Careful assessments and treatment of underlying causes is important to alleviate patients' distress.

Thirst in Patients with Heart Failure : Description of thirst dimensions and associated factors with thirst

“…Thirst has previously been measured and described in healthy persons, 27 in patients with renal failure, [28][29][30] terminal illness, 31,32 diabetes, 33,34 in critically ill patients at intensive care unit, 35,36 and in patients with HF. 11,20 Thirst has mostly been described in research with the sensation of intensity, 11,26,28,35,[37][38][39][40][41] which refers to the strength of the thirst.…”

“…The VAS has been used in studies to measure pain and quality of life as well as thirst intensity in different populations. 31,41,95,100 It has been validated for patients with HF.…”

“…Stress measured with saliva cortisol increased from baseline to study end in patients with high thirst intensity (median 20 nmol/L to 26 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37];…”

“…P=0.001), while cortisol remained unchanged in patients with low thirst intensity (25 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] nmol/L to 23 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]; P=0.58).…”

Effects of tap water, electrolyte solution, and spontaneous and furosemide-stimulated urinary excretion on thirst

“…For this purpose, the study participants were asked to mark with a cross on a 100 mm line to rate their thirst from none (0 mm) to worst possible thirst (100 mm). The VAS scale is commonly used to estimate pain and quality of life [4] , and to evaluate thirst in patients with cancer, with renal or heart failure, and in patients during trauma resuscitation [5][6][7][8] . However, the scale has not been used previously to grade thirst in volunteers subjected to controlled alterations of the fluid balance.…”