Takashi Higashiguchi1, Junichi Ikegaki2, Kazuya Sobue3, Yoichiro Tamura4, Nobuhisa Nakajima5, Akihiko Futamura6, Mitsunori Miyashita7, Naoharu Mori1, Akio Inui8, Keiichiro Ohta9, Toyoshi Hosokawa10. 1. Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Aichi. 2. Department of Pain Medicine, Palliative Care Hyogo Cancer Center, Akashi-City, Hyogo. 3. Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya. 4. Palliative Medicine Yamanote Hospital, Ibaraki. 5. Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Miyagi. 6. Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Mie. 7. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi. 8. Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical & Dental Sciences, Kagoshima. 9. Department of Surgery, Nippon Medical School, Tokyo. 10. Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Abstract
BACKGROUND: Japan's first guidelines for parenteral fluid management for terminal cancer patients were issued in 2006. These guidelines focused on the fluid levels to administer to patients with a remaining life expectancy of 1-2 months. However, recent refinement of the concept of cachexia is prompting caregivers worldwide to rethink parenteral fluid management for terminal cancer patients. OBJECTIVE: Our objective was to develop guidelines for parenteral fluid management for terminal cancer patients with a remaining life expectancy of 1 month, a point when cachexia generally begins to severely adversely affect the body. METHODS: The Japanese Society for Palliative Medicine appointed a Guidelines Working Practitioner Group consisting of a multidisciplinary team of specialists. In response to 26 clinical questions on parenteral fluid management for terminal cancer patients, the Working Group used the Delphi method to reach consensus on the recommendability and evidence level of 89 relevant manuscripts identified through a systematic literature review. The Working Group then had an outside committee reviews the draft guidelines validity before authoring the final version. RESULTS: The resulting clinically aligned guidelines contain specific recommendations (25 recommendations on physical suffering/remaining life expectancy, 10 nursing-related recommendations and 4 ethical recommendations) assessed using the Delphi method and by an outside committee. CONCLUSIONS: Japanese Society for Palliative Medicine released a revised edition of the Guidelines for Parenteral Fluid Management for Terminal Cancer Patients, which are based on medical evidence and consider the pathologic features of cachexia. We recommend that caregivers carefully evaluate the clinical usefulness of the guidelines.
BACKGROUND: Japan's first guidelines for parenteral fluid management for terminal cancerpatients were issued in 2006. These guidelines focused on the fluid levels to administer to patients with a remaining life expectancy of 1-2 months. However, recent refinement of the concept of cachexia is prompting caregivers worldwide to rethink parenteral fluid management for terminal cancerpatients. OBJECTIVE: Our objective was to develop guidelines for parenteral fluid management for terminal cancerpatients with a remaining life expectancy of 1 month, a point when cachexia generally begins to severely adversely affect the body. METHODS: The Japanese Society for Palliative Medicine appointed a Guidelines Working Practitioner Group consisting of a multidisciplinary team of specialists. In response to 26 clinical questions on parenteral fluid management for terminal cancerpatients, the Working Group used the Delphi method to reach consensus on the recommendability and evidence level of 89 relevant manuscripts identified through a systematic literature review. The Working Group then had an outside committee reviews the draft guidelines validity before authoring the final version. RESULTS: The resulting clinically aligned guidelines contain specific recommendations (25 recommendations on physical suffering/remaining life expectancy, 10 nursing-related recommendations and 4 ethical recommendations) assessed using the Delphi method and by an outside committee. CONCLUSIONS: Japanese Society for Palliative Medicine released a revised edition of the Guidelines for Parenteral Fluid Management for Terminal CancerPatients, which are based on medical evidence and consider the pathologic features of cachexia. We recommend that caregivers carefully evaluate the clinical usefulness of the guidelines.