Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies

Abstract

Artificial hydration therapy could alleviate membranous dehydration signs, but could worsen peripheral edema, ascites and pleural effusions. It is suggested that the potential benefits of artificial hydration therapy should be balanced with the risk of worsening fluid retention symptoms. Further clinical studies are strongly needed to identify the effects of artificial hydration therapy on overall patient well-being, and an individualized treatment and close monitoring of dehydration and fluid retention symptoms is strongly recommended.

Parenteral Hydration in Patients With Advanced Cancer: A Multicenter, Double-Blind, Placebo-Controlled Randomized Trial

“…41 We did not observe any significant differences in survival between the two study arms. Consistent with other studies, 6,[42][43][44][45][46] our study suggests that patients with a short life expectancy may not benefit from hydration in regard to survival.…”

“…Participating sites included Silverado Hospice, Odyssey Hospice, Vitas Hospice, Houston Hospice, and Christus VNA Hospice in the Greater Houston area. Inclusion criteria were a diagnosis of advanced cancer (ie, locally recurrent or metastatic disease), an age of 18 years or older, an admission to hospice, a reduced oral intake of fluids with evidence of mild or moderate dehydration as defined by decreased skin turgor in subclavicular region (Ͼ 2 seconds) and a score of Ն 2 of 5 in the clinical dehydration assessment (see Study Assessments), 6 an intensity of Ն 1 on a 0 to 10 scale (0 ϭ no symptom, 10 ϭ the worst possible symptom) for fatigue and two of the three other target symptoms (hallucinations, sedation, and myoclonus), a life expectancy Ն 1 week, availability of a primary caregiver, a Memorial Delirium Assessment Scale (MDAS) score less than 13, an ability to give written informed consent, and geographic accessibility (within 60 miles of The University of Texas MD Anderson Cancer Center). Patients were excluded if they had severe dehydration, defined as decreased blood pressure or low perfusion of limbs, decreased level of consciousness, or no urine output for 12 hours, history or clinical evidence of renal failure with creatinine more than 1.5ϫ upper normal limit, history or clinical evidence of congestive heart failure, or history of bleeding disorders demonstrated by clinical evidence of active bleeding, hematuria, hematoma, ecchymoses, and petechiae.…”

“…16 Hydration status was assessed with the dehydration assessment scale on the basis of three physical findings, moisture on the mucous membranes of the mouth (0 ϭ moist; 1 ϭ somewhat dry; 2 ϭ dry), axillary moisture (0 ϭ moist; 1 ϭ dry), and sunkenness of the eyes (0 ϭ normal, 1 ϭ slight sunken, 2 ϭ sunken). 6 These signs are selected on the basis of their significant correlations with biologic dehydration, as previously confirmed in elderly patients. [17][18][19] The dehydration score (range, 0 to 7) is calculated as the total of these three scores.…”

¿Es necesario hidratar artificialmente a los pacientes terminales?

“…-A. Palma et al p < 0,001) y derrame pleural (15% vs 5,4%, p = 0,016), comparado con el grupo sin HA. Estos datos concuerdan con la hipótesis de que la HA puede aumentar la retención de fl uidos en PT, sin embargo, nos parece relevante destacar que los médicos no estaban en un sistema de evaluación ciega y que las soluciones y volúmenes aportados no fueron estandarizados 23 . En base a lo anterior, nos parece que es probable que el riesgo de acumulación de fl uidos secundaria a HA sea signifi cativo en PT caquéc-ticos, que reciben volúmenes mayores a l,5-2 l diarios de soluciones salinas, práctica médica rutinaria, que está orientada a lograr expansión del volumen extracelular y no a alivio sintomático.…”

“…Por lo tanto, es lógico pensar que PT con síntomas neurológicos, especialmente aquellos que consumen opioides, puedan benefi ciarse del uso de HA, sin embargo, este punto no ha sido completamente dilucidado y diversos estudios muestran resultados contradictorios. En el estudio prospectivo de Morita mencionado anteriormente, al igual que en otros estudios, no se encontraron diferencias signifi cativas en la incidencia de delirium, agitación o mioclonías cuando se compararon PT hidratados y no hidratados en sus últimas tres semanas de vida 23 . Sin embargo, no toda la información disponible es negativa.…”