The role of hydration in causing or alleviating suffering in patients with advanced cancer is poorly understood and remains controversial. Most dying cancer patients have reduced oral intake in the last days of life. This may be related to symptoms arising from the cancer or its treatment, such as dysphagia, anorexia, nausea, vomiting, or mechanical problems such as bowel obstruction. Accordingly, the subject of clinically assisted hydration (CAH) is emotive amongst patients and their carers, with the omission or withdrawal of CAH potentially viewed as hastening death in some instances. Current hydration assessment methods are limited in cancer patients approaching death. Bioelectrical impedance vector analysis (BIVA) is an accurate validated method of assessing body composition; however its clinical use in advanced cancer is uncertain. This study aims to measure hydration in advanced cancer patients using BIVA, in order, to determine the relationship between symptoms, physical signs and biochemistry. BIVA was used to evaluate hydration in advanced cancer patients within a hospice in the UK. Total body water (TBW) was estimated using the impedance index (Height2/Resistance [H2/R]). Regression analysis determined the predictive properties of clinical variables on H2/R. Assessed items included: performance status (ECOG), symptoms (Burge-4 score), physical signs (Morita Dehydration Score) and biochemistry. Ninety patients participated (recruitment rate = 76.3%). Hydration status was normal in 43 (47.8%), ‘more hydrated’ in 37 (41.1%) and ‘less hydrated’ in 10 (11.1%) patients. A multiple regression analysis was conducted. H2/R was significantly predicted by female gender (Beta = -13.85, p<.001), the Burge-4 score (Beta = -0.29, p=.04), the Morita dehydration score (Beta = -2.55, p=.02) and oedema (Beta = 2.55, p<.001). Median survival was significantly shorter in ‘less hydrated’ patients (44 vs. 68 days; p=.04) and in pre-renal failure (44 vs. 100 days; p=.003). Higher values of H2/R were associated with improved survival (HR=0.98 [95%CI= .96, .99], p=0.01). The results demonstrate that in advanced cancer, hydration status (as measured by H2/R and BIVA) relates to clinically measurable signs and symptoms. Lower TBW volume was associated with female gender and also linked with higher scores for symptoms and physical signs. Higher TBW was associated with oedema. H2/R, BIVA and pre-renal failure were independent predictors of survival. Further work is needed to determine how BIVA can be used to guide the management of fluid states in advanced cancer.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:679873 |
| Date | January 2015 |
| Creators | Nwosu, Amarachukwu |
| Publisher | University of Liverpool |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://livrepository.liverpool.ac.uk/2008486/ |
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