A clinical study on the influence of hydration volume on the signs of terminally ill cancer patients with abdominal malignancies

Abstract

Background: Current discrepancies in the practice of artificial hydration therapy for terminally ill cancer patients have the potential to cause serious clinical problems.

Purpose: The study's purpose was to explore the influence of hydration volume on the sings during the last three weeks of life in terminally ill cancer patients.

Methods: This was a prospective, observational study of 75 consecutive terminally ill patients with abdominal malignancies during the last four years. Primary responsible physicians evaluated the severity of membranous dehydration (calculated on the basis of three physical findings), peripheral edema (calculated on the basis of seven physical findings), ascites and pleural effusion (rated as physically undetectable to symptomatic), bronchial secretion, and hyperactive delirium.

Results: Patients were classified into two groups: the hydration group (n=32), receiving 1000 mL or more of artificial hydration per day, one and three weeks before death, and the nonhydration group (n=43). The percentage of patients with deterioration in dehydration score in the final three weeks was significantly higher in the nonhydration group than in the hydration group (35% versus 13%, p=0.027), while the percentages of patients whose symptom scores for edema, ascites, and bronchial secretion increased were significantly higher in the hydration group than in the nonhydration group (57% versus 33%, p=0.040; 34% versus 14%, p=0.037; 41% versus 19%, p=0.036, respectively). There were no significant differences in the degree of pleural effusion or the prevalence of hyperactive delirium between these groups.

Conclusions: The potential benefits of artificial hydration therapy should be balanced with the risk of worsening fluid retention signs.