The last days of life: symptom burden and impact on nutrition and hydration in cancer patients

Abstract

Purpose of review: To examine the symptom burden in cancer patients during the last days of life, its impact on nutrition and hydration, and the role of artificial nutrition and hydration in the final days.

Recent findings: During 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 during the last days of life. Artificial nutrition is not recommended because of its invasive nature, whereas 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 during the last days of life.

Figure 1. Contributors to Decreased Oral Intake in the Last Days of Life

In the final days, cancer patients often have limited desire to eat/drink (anorexia). This, coupled with refractory cachexia and an array of nutritional impact symptoms, contribute to persistent weight loss and functional decline.