To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

Abstract

Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross‐Cultural Study to Elucidate the Dying Process

“…To our knowledge, this is the first international observational study with a large sample size that demonstrates the impact of the AH amount with a clear range on QOD, and the result is concordant with our preliminary study findings. 13 The 250 to 499 mL range of AH exerts a beneficial effect on every domain of GDS. Possibly, it may be because clinicians can order a low volume of AH due to optimal symptom control, patients' and families' acceptance of death, and their favorable psychological status.…”

“…The daily hydration volume was defined as parenteral formulated AH and other fluids for medical purposes, such as antibiotics, albumin, or blood transfusion. 5,13 Nasogastric tube or jejunostomy feeding and total parenteral nutrition were regarded as artificial nutrition and not included in the AH. 9,24 Based on a previous study, 25 we divided the AH amount into different groups by 250 mL to compare their clinical segmentation difference.…”

“…10,11 In Asia, families consider AH as basic support to prevent starvation during EOL for patients with poor oral intake. 12,13 An American study reported that nearly half of patients (48%) and their caregivers (56%) viewed AH as food or as both food and medicine. 14 With the various points of view among patients, families, and medical professionals, discussions on AH use often results in psychological distress and may influence their perception of patients' QOD.…”

“…Although AH is not generally regarded as routine management during end‐of‐life (EOL) care, some patients and families consider AH meaningful and an improvement to patient QOL, dignity, and good quality of dying (QOD) 10,11 . In Asia, families consider AH as basic support to prevent starvation during EOL for patients with poor oral intake 12,13 . An American study reported that nearly half of patients (48%) and their caregivers (56%) viewed AH as food or as both food and medicine 14 .…”

Attitudes Toward End-Of-Life Decisions Other Than Assisted Death Amongst Doctors in Northern Portugal

“…However, if patients are unable to do so, the provision of nutrition by arti cial means is controversial; if this is basic care or medical treatment is debatable. It would be stressed that what is asked in this study is about patients with advanced diseases and in this case, hydration seems not to prolong life, although it may have an impact on quality of life [21]. There are different situations of patients without an advanced disease who could have their life prolonged if feeding were maintained, such as in cases of permanent vegetative state [22].…”