The last days of life

Abstract

Purpose of review We will review the symptom burden in cancer patients in the last days of life, its impact on nutrition and hydration, and the role of artificial nutrition and hydration in patients with days of life expectancy. Recent findings In the last days of life, cancer patients often experience progressive functional decline and worsening symptom burden. Many symptoms such as anorexia-cachexia, dysphagia and delirium could impair oral intake. These, coupled with refractory cachexia, contribute to persistent weight loss and decreased quality of life. Furthermore, the inability to eat/drink and body image changes can result in emotional distress for patients and caregivers. Clinicians caring for these individuals need to ensure longitudinal communication about goals of care, education about the natural process of dying, optimization of symptom management, and provide appropriate emotional support for patients and caregivers. There is a lack of evidence to support that artificial nutrition and hydration can improve outcomes in the last days of life. Artificial nutrition is not recommended because of its invasive nature, while artificial hydration may be considered on a case-by-case basis. Summary This review highlights the need to conduct further research on symptom burden, nutrition and hydration in the last days of life.

Nutrition Intervention through Interdisciplinary Medical Treatment in Hospice Patients: From Admission to Death

“…Generally, weight loss occurs as cancer progresses due to accelerated metabolism [ 3 ], whereas the digestive functions and the amount of required energy decrease in the terminal stages [ 5 ]. Nutrition interventions for hospice patients have limitations because there are no guidelines for the estimation of the recommended nutritional intake based on changes in the condition of patients near the end of life.…”

“…According to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines [ 11 ], AN is recommended when life expectancy is at least 2–3 months; however, nutrition support does not extend survival when life expectancy is low. Hui et al [ 3 ] also did not recommend AN for patients with life expectancy of less than 1 month. After the patient was transferred to the hospice, the AN supply was reduced to 17% in contrast to AN supplying 40%–80% of the required intake through the central line in the general ward.…”

“…However, due to anorexia, dysphagia, weakness, and confusion, which are the main symptoms experienced by patients at the end of life, oral intake decreases and is accompanied by weight loss. Consequently, artificial nutrition (AN) is required in a subset of patients [ 3 ]. According to the literature, approximately 50% of hospice patients are affected by malnutrition and weight loss, and infection increases due to malnutrition [ 4 ], which may diminish patient quality of life [ 3 ].…”

“…Consequently, artificial nutrition (AN) is required in a subset of patients [ 3 ]. According to the literature, approximately 50% of hospice patients are affected by malnutrition and weight loss, and infection increases due to malnutrition [ 4 ], which may diminish patient quality of life [ 3 ]. Therefore, nutrition management should be continuously performed in order to delay deterioration and improve the quality of life of hospice patients.…”

Relationship between the Functional Oral Intake Scale (FOIS) and the Self-Efficacy Scale among Cancer Patients: A Cross-Sectional Study

“…In cancer patients, it is highly likely that symptoms such as swallowing dysfunction (dysphagia) and appetite loss will become a focus of supportive care [ 1 ]. Dysphagia may lead to greater distress for not only the cancer patients (due to the withholding or discontinuation of consumption of fluids and solids) but also for their caregiver(s) (due to the increased physical and mental burden of preparing and assisting the patient with meals) [ 2 ].…”