Rony Dev1, Shalini Dalal, Eduardo Bruera. 1. Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abstract
PURPOSE OF REVIEW: This review aims to update healthcare providers on the role of parenteral nutrition/hydration in terminal patients and highlight recent research. RECENT FINDINGS: Cachexia is felt to be refractory to treatment at the last stages of life. The majority of terminally ill patients will derive no benefit from parenteral nutrition with some exceptions including patients with a good functional status and a nonfunctional gastrointestinal tract or a slow growing tumor.Dehydration can potentially be reversible in patients at the end of life. However, recent research examining parenteral hydration reveals no clear clinical benefits on symptom burden or survival for terminally ill cancer patients with the exception of possibly reversing the complication of delirium. SUMMARY: Hydration and nutrition are essential for the maintenance of life. In patients at the end of life, artificial hydration and nutrition pose clinical, ethical, and logistical dilemmas. No strong evidence exists supporting the use of parenteral hydration/nutrition for the majority of terminally ill patients; however, a subset of patients may derive some benefit. Uncertainty about determining prognosis, psychosocial factors, and perceptions of perceived benefits results in artificial nutrition/hydration being initiated in terminally ill patients. Discontinuation of artificial support can result in distress for patients, family members, and healthcare providers.
PURPOSE OF REVIEW: This review aims to update healthcare providers on the role of parenteral nutrition/hydration in terminal patients and highlight recent research. RECENT FINDINGS:Cachexia is felt to be refractory to treatment at the last stages of life. The majority of terminally ill patients will derive no benefit from parenteral nutrition with some exceptions including patients with a good functional status and a nonfunctional gastrointestinal tract or a slow growing tumor.Dehydration can potentially be reversible in patients at the end of life. However, recent research examining parenteral hydration reveals no clear clinical benefits on symptom burden or survival for terminally ill cancerpatients with the exception of possibly reversing the complication of delirium. SUMMARY: Hydration and nutrition are essential for the maintenance of life. In patients at the end of life, artificial hydration and nutrition pose clinical, ethical, and logistical dilemmas. No strong evidence exists supporting the use of parenteral hydration/nutrition for the majority of terminally ill patients; however, a subset of patients may derive some benefit. Uncertainty about determining prognosis, psychosocial factors, and perceptions of perceived benefits results in artificial nutrition/hydration being initiated in terminally ill patients. Discontinuation of artificial support can result in distress for patients, family members, and healthcare providers.