Tipping point: When patients stop eating and drinking in the last phase of their life

Blum, David; Jensen, Wiebke; Ullrich, Anneke; Hlawatsch, Cornelia; Bokemeyer, Carsten

doi:10.1016/j.clnesp.2020.04.012

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…Other reports, however, indicate that the use of artificial nutrition, defined as a medical treatment that allows a non-oral mechanical feeding, in the end of life care is limited to 3% of the patients [81]. Despite this remains an unresolved issue [82,83], a tailored approach to optimize resources in every single patient is highly desirable.…”

Section: Nutritional Care During Later Treatment Lines and Beyond: Is The Final Hurdle Worth Jumping?mentioning

confidence: 99%

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Aprile¹,

Basile²,

Giaretta³

et al. 2021

Nutrients

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Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients’ overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients’ nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.

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Section: Nutritional Care During Later Treatment Lines and Beyond: Is The Final Hurdle Worth Jumping?mentioning

confidence: 99%

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Aprile¹,

Basile²,

Giaretta³

et al. 2021

Nutrients

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show abstract

“…Blum et al [2] pointed out that neither enteral nutrition nor parenteral supplementation can improve the symptoms and physical functions of terminal patients when the patient's body system deteriorates. On the contrary, continuous supplementation of nutrition and hydration may cause numerous side effects in terminal patients, including pulmonary edema caused by excessive fluid retention in the body, skin damage, increased activity intolerance, and even increased difficulty breathing and dyspnea, which are consistent with the results of this study.…”

Section: Taiwanese Food Culture and Homology Of Medicine And Foodmentioning

confidence: 99%

“…Excessive nutrient supplementation will not improve the physical conditions of patients and may even increase physical burden to the patients due to excessive hydration through intravenous injection, resulting in ascites and edema. Furthermore, continuous intravenous injection also will interfere with discharging of patients for in-home care [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Do Nursing Staff Accept no Artificial Nutrition and Hydration for Terminal Patients?

2022

Int J Nurs Health Care Res

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Background: Hospice care remains a difficult task in clinical practice. Whether it is necessary to provide sufficient amount of artificial nutrition and hydration (ANH) to a terminal patient when the patient's body system deteriorates and is unable to absorb is an important issue for hospice care and is affected by Taiwanese medicine and food culture. Especially, there are quite different viewpoint in Taiwanese food culture for terminal patients from metropolitan to rural area. Objective: To explore the perspectives of clinical nursing staff in providing artificial nutrition and hydration to terminal patients when the patient's body system deteriorates and examine factors affecting Taiwanese food culture. Methods: A cross-sectional study with 393 clinical nursing staff from a teaching hospital in the central metropolitan area and eastern rural area, and the subjects were enrolled from March 2018 to March 2020. Taiwanese Food Cultural Recognition Scale and Clinical Artificial Nutrition and Hydration Scale were analyzed by using SPSS Statistics 22.0 for independent sample t-test, oneway ANOVA, Scheffe posterior comparison, and hierarchical regression. Results:1. Clinical nursing staff in urban areas showed better recognition of Taiwanese food culture (7.11 ± 1.67;6.90 ± 1.96) and better acceptance of ANH (101.84 ± 8.76 ; 99.24 ± 9.06) than those in rural areas. 2. Clinical nursing staff in urban areas had better recognition of and a more positive attitude towards non-ANH than those in rural areas (p＜0.01**). Moreover, clinical nursing staff in urban areas had better recognition of the homology of medicine and food (p=0.02*) recognized by Taiwanese medicine and food culture. 3. Clinical nursing staff in rural areas had a more positive attitude towards accepting non-ANH, in "physical function" and "digestive function" ( p＜0.001***; p＜0.01**). 4. There is a significant difference between clinical nursing staff's affiliated institution/years of work experience and their recognition of non-ANH. Clinical nursing staff had a more positive attitude towards non-ANH if they participated in courses and training and had a better understanding of the concept of hospice care and of the timing as well as decision-making for ANH. 5. Those who participated in courses and training and had a better understanding of the concept of hospice care showed better recognition of the customs, family values and homology of medicine and food and were more likely to accept ANH. Conclusions: Providing artificial nutrition and hydration as part of hospice care should be cautious. Caregivers should pay more attention to improve their hospice care skills, maintain a positive attitude when facing death at the end stage and provide comfort care, and all of these help to provide a reference for giving artificial nutrition and hydration to terminal patients and relevant decision-making.

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Tipping point: When patients stop eating and drinking in the last phase of their life

Cited by 2 publications

References 9 publications

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Do Nursing Staff Accept no Artificial Nutrition and Hydration for Terminal Patients?

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