In the Journals Plus

Fluids extend survival at end of life for patients with cancer

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February 20, 2018

Patients with cancer at end of life who received assisted hydration survived nearly 1.5 days longer than those who did not receive fluids, according to study results.

Patients receiving fluids also appeared to have good symptom control and to suffer from minimal side effects.

However, researchers noted this was a feasibility study and, thus, was not powered to compare clinical outcomes between the groups.

“The provision of clinically assisted hydration at the end of life is one of the most contentious issues in medicine,” Andrew N. Davies, MB BS, MSc, MD, FRCP, consultant in palliative medicine at Royal Surrey County Hospital in the UK, said in a press release.

“The reasons for contention include the lack of evidence for or against clinically assisted hydration, the disparate opinions of health care professionals about clinically assisted hydration, and the generally positive opinions of patients and their [caretakers] about clinically assisted hydration (and the generally negative opinions about withholding or withdrawing clinically assisted hydration),” Davies and colleagues wrote in the study.

The use of clinically assisted hydration varies, ranging from 18% to 88% in the last week of life among patients with cancer.

Davies and colleagues evaluated data from 200 patients unable to maintain sufficient oral fluid intake who were in the last week of life. Patients received treatment at one of four cancer centers and eight hospices randomly assigned to treat patients with clinically assisted hydration and mouth care in addition to standard care or standard care alone. Patient follow-up occurred every 4 hours.

The researchers aimed to assess the process and management of patients to determine feasibility for a future randomized controlled trial assessing the role of clinically assisted hydration at the end of life.

Only 36.5% of participants received hydration assistance because a large hospice was assigned to administer standard of care and no similar large center was randomized to hydration assistance.

Median survival among patients receiving hydration assistance was 4.26 days (95% CI, 3.34-6.15) compared with 2.89 days (95% CI, 2.4-4.04) in the standard-care group (P = .0387).

Survival at 3 days improved among patients who received hydration (HR = 0.35; 95% CI, 0.21-0.58).

“The results of this study are certainly interesting, but a larger study is needed to confirm the role of clinically assisted hydration at the end of life,” Davies said in the release. “For some patients and their families living an extra day or so may be extremely important, as it can give them an opportunity to say their goodbyes, have family arrive from abroad, write a will or even get married. Nevertheless, for other patients, living an extra day or so may be the worst thing possible.”

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Thirty-nine percent of participants (n = 28) discontinued hydration assistance due to adverse effects, none of which were rated as severe or worse. Primary reasons for discontinuation included localized edema (n = 13), respiratory secretions (n = 6), generalized edema (n = 5), site problems (n = 2), and nausea and vomiting (n = 1).

Limitations of the study included reliance on clinical assessments, unequal distribution of patients to the treatment arms and the lack of nonwhite participants.

“Hydration plays a key role in delaying the dying process; why this is remains unknown. We will be exploring this in further studies, and the results from this will help improve quality in end-of-life care,” Agnieszka Michael, MD PhD, medical director of the clinical trials unit at the University of Surrey, said in the release. – by Cassie Homer

Disclosures: The authors report no relevant financial disclosures.