Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects

• Published in: Annals of oncology Vol. 22; no. 7; pp. 1478 - 1486
• Main Authors: Raijmakers, N.J.H., van Zuylen, L., Costantini, M., Caraceni, A., Clark, J., Lundquist, G., Voltz, R., Ellershaw, J.E., van der Heide, A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.2011; Oxford University Press
• Subjects: Antineoplastic agents; artificial hydration; artificial nutrition; Biological and medical sciences; dying phase; end of life; Fluid Therapy; Humans; Medical sciences; Neoplasms - therapy; Nutritional Support; palliative care; Patient Acceptance of Health Care; Pharmacology. Drug treatments; Terminal Care; artificial hydration; end of life; artificial nutrition; terminal care; palliative care; dying phase; Human; Hydration; Nutrition; Patient; Systematic review; Review; Malignant tumor; Care; Feeding; Diet; Palliative care; Bibliographic review; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdq620

The benefits and burdens of artificial nutrition (AN) and artificial hydration (AH) in end-of-life care are unclear. We carried out a literature review on the use of AN and AH in the last days of life of cancer patients. We systematically searched for papers in PubMed, CINAHL, PsycInfo and EMBASE. All English papers published between January 1998 and July 2009 that contained data on frequencies or effects of AN or AH in cancer patients in the last days of life were included. Reported percentages of patients receiving AN or AH in the last week of life varied from 3% to 53% and from 12% to 88%, respectively. Five studies reported on the effects of AH: two found positive effects (less chronic nausea, less physical dehydration signs), two found negative effects (more ascites, more intestinal drainage) and four found also no effects on terminal delirium, thirst, chronic nausea and fluid overload. No study reported on the sole effect of AN. Providing AN or AH to cancer patients who are in the last week of life is a frequent practice. The effects on comfort, symptoms and length of survival seem limited. Further research will contribute to better understanding of this important topic in end-of-life care.