Background The role of hydration in causing or alleviating suffering in advanced cancer is poorly understood. Bioelectrical impedance analysis (BIA) is an accurate validated method of assessing hydration status. Previous BIA research demonstrates significant relationships with hydration status, symptoms, and survival in advanced cancer. Further work is needed to study these associations in the dying.
Aim To evaluate hydration and its relationship with clinical symptoms in dying cancer patients.
Methodology We conducted an observational study of patients with advanced cancer in 3 centres (two hospices and a hospital-based specialist palliative care in-patient unit). We used an advance consent methodology to conduct hydration assessments of participants as they entered the dying phase. We recorded hydration status (via BIA Impedance index: Height – H 2/Resistance - R), symptoms, physical signs, and quality-of-life assessments.
Results One hundred and twenty-five people were recruited (males n=74 (59.2%), females, n=51 (40.8%). We repeated assessments in 18 (14.4%) participants when they were dying. Hydration status (H2/R) of the dying patients (n= 18, M= 49.55, SD= 16.00) was not significantly different compared to their baseline hydration assessment (M= 50.96, SD= 12.13; t(17)= 0.636, p = 0.53).
Increasing hydration level (increased H2/R) was significantly associated with oedema (r= 0.509, p<0.001). Lower hydration level (reduced H2/R) was associated with patient concern of poorer health (r=-0.19, p=0.034), improved sleep (r=-0.235, p=0.009), poorer appetite (r= -0.273, p=0.002), increased anxiety (r= -0.192, p=0.032), worsening dry mouth (r= -0.242, p=0.007) and sunken eyes (r= -0.333, p<0.001).
Conclusions Hydration status was significantly associated with physical signs and symptoms in advanced disease. No significant difference in hydration status were observable in dying patients compared to baseline. Bioimpedance analysis was well tolerated and has potential use as a non-invasive tool to evaluate hydration status in the dying.
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