Effects of Parenteral Hydration in Terminally Ill Cancer Patients: A Preliminary Study

Bruera, Éduardo; Sala, Raúl; Rico, María Antonieta; Moyano, Jairo; Centeno, Carlos; Willey, Jie; Palmer, J. Lynn

doi:10.1200/jco.2005.04.069

Cited by 147 publications

(89 citation statements)

References 23 publications

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“…These findings are similar to our previous hydration study 3 and suggest that independent of the amount of hydration received, frequent visits and assessments by research nurses may result in significant improvement in the perception of overall benefit, to the extent that it may even overshadow the biomedical effect of hydration. One possible way to circumvent the potential dramatic effect of nursing interventions may be by training family members to administer fluids and limiting the frequency of phone calls and assessments to the first and last day of study.…”

Section: Discussionsupporting

confidence: 89%

“…A volume of 1,000 mL per day was chosen on the basis of previous studies demonstrating that this amount was adequate to improve clinical outcomes in palliative care patients. 3,7 Patients were approached and assessed by the research nurses at home on referral from the hospice team.…”

Section: Study Design and Interventionsmentioning

confidence: 99%

“…The only double-blind randomized controlled study on this topic, which was conducted by our group, suggested that parenteral hydration decreases some symptoms associated with dehydration in patients with advanced cancer compared with placebo. 3 In addition, several retrospective studies have suggested that hydration can reduce neuropsychiatric symptoms such as sedation, hallucinations, myoclonus, and fatigue. 4,5 We conducted this randomized controlled trial to determine whether parenteral hydration was superior to placebo in improving symptoms associated with dehydration, delayed the onset and/or severity of delirium, and had an effect on quality of…”

Section: Introductionmentioning

confidence: 99%

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

Bruera¹,

Hui²,

Dalal³

et al. 2013

JCO

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223

180

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Purpose The vast majority of patients with cancer at the end of life receive parenteral hydration in hospitals and no hydration in hospice, with limited evidence supporting either practice. In this randomized controlled trial, we determined the effect of hydration on symptoms associated with dehydration, quality of life, and survival in patients with advanced cancer. Patients and Methods We randomly assigned 129 patients with cancer from six hospices to receive parenteral hydration (normal saline 1 L per day) or placebo (normal saline 100 mL per day) daily over 4 hours. The primary outcome was change in the sum of four dehydration symptoms (fatigue, myoclonus, sedation and hallucinations, 0 = best and 40 = worst possible) between day 4 and baseline. Secondary outcomes included Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale (MDAS), Nursing Delirium Screening Scale (NuDESC), Unified Myoclonus Rating Scale (UMRS), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), Dehydration Assessment Scale, creatinine, urea, and overall survival. Intention-to-treat analysis was conducted to examine the change by day 4 ± 2 and day 7 ± 2 between groups. Results The hydration (n = 63) and placebo (n = 66) groups had similar baseline characteristics. We found no significant differences between the two groups for change in the sum of four dehydration symptoms (−3.3 v −2.8, P = .77), ESAS (all nonsignificant), MDAS (1 v 3.5, P = .084), NuDESC (0 v 0, P = .13), and UMRS (0 v 0, P = .54) by day 4. Results for day 7, including FACIT-F, were similar. Overall survival did not differ between the two groups (median, 21 v 15 days, P = .83). Conclusion Hydration at 1 L per day did not improve symptoms, quality of life, or survival compared with placebo.

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Section: Discussionsupporting

confidence: 89%

Section: Study Design and Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bruera¹,

Hui²,

Dalal³

et al. 2013

JCO

Self Cite

223

180

View full text Add to dashboard Cite

show abstract

“…En el grupo hidratado se observó una disminución signifi cativa de sedación y mioclonías (83% vs 33% y 83% vs 47%, p < 0,05, respectivamente). Tomando los resultados globales que incluyen la variación de alucinaciones, mioclonías, fatiga y sedación, el benefi cio también fue signifi cativo (73% vs 49%, p < 0,006) 25 . Estos datos son concordantes con los resultados de un trabajo prospectivo de Lawlor, quien evaluó la presencia de factores asociados a reversibilidad de delirium en 113 PT admitidos a una UCP.…”

Section: Síntomas Neurológicos En Ptunclassified

¿Es necesario hidratar artificialmente a los pacientes terminales?

2011

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. Los reportes sobre prácticas de hidratación habituales en diversas Unidades de Cuidados Paliativos (UCP) muestran gran variabilidad, utilizándose desde la hidratación endovenosa en altos volúmenes, hasta la suspensión permanente de toda hidratación. Muchas veces estas conductas se basan en datos clínicos anecdóticos y no en evidencia clara respecto de los riesgos y benefi cios de la HA en PT 2-4 . Entre los argumentos en contra de la HA se han incluido diversos riesgos, como la acumulación de fl uidos y la prolongación de la agonía. Entre las indicaciones de HA en PT se han considerado posibles benefi cios, como la prevención o el alivio de síntomas, que son frecuentes y causan gran estrés en las fases fi nales de la vida (Tabla 1).La controversia asociada a la indicación de HA en PT no sólo involucra posturas médicas contradictorias desde un punto de vista técnico, sino también un intenso debate desde la perspectiva ética. Algunas de las preguntas éticamente relevantes más debatidas en este contexto, son si la HA puede prolongar la vida o si su omisión puede acelerar la muerte; si la HA puede contribuir a conservar el ejercicio de las facultades superiores; si la HA tiene un signifi cado simbólico, cultural o religioso que deba ser respetado en la toma de decisiones al fi nal de la vida. Estas preguntas tienen evidentes implicancias éticas, pues están directamente relacionadas con algunos valores y principios morales muy relevantes en la atención de PT, como el respeto por la vida, la muerte y la dignidad humana; la obligación moral de implementar cuidados médicos proporcionados y el deber de fomentar el ejercicio de la autonomía de los pacientes 5-7 . El objetivo de este artículo es revisar benefi cios y riesgos clínicos asociados a la HA en PT, haciendo alusión a algunos principios éticos involucrados.

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“…So, reliable intravenous (IV) access is an important issue in terminally ill cancer patients (2,3). However, these terminally ill cancer patients had limited or no peripheral venous access due to edema or thrombophlebitis caused by long-term IV therapy including chemotherapy and blood transfusions.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

Park

Lim

Hong

et al. 2014

Korean J Hosp Palliat Care

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Effects of Parenteral Hydration in Terminally Ill Cancer Patients: A Preliminary Study

Abstract: Parenteral hydration decreased symptoms of dehydration in terminally ill cancer patients who had decreased fluid intake. Hydration was well tolerated, and a placebo effect was observed. Studies with larger samples and a longer follow-up period are justified.

Cited by 147 publications

References 23 publications

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

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

¿Es necesario hidratar artificialmente a los pacientes terminales?

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

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