End-of-Life Parenteral Hydration Did Not Improve Symptoms, Quality of Life

Giving patients at the end of life regular parenteral hydration of 1 L of saline per day did not improve symptoms associated with hydration, quality of life, or survival, according to a randomized, placebo controlled study.

The results, published in the Journal of Clinical Oncology, suggest that parenteral hydration in patients with mild-to-moderate dehydration during the last weeks of life may be no more effective than placebo, according to researchers led by Eduardo Bruera, MD, chair of the department of palliative care and rehabilitation medicine at the University of Texas M.D. Anderson Cancer.

According to background information in the article, most patients with advanced cancer will decrease their intake of fluids before death as a result of the deteriorating symptoms associated with their disease.

“The role of giving water during the last days of life is highly controversial,” Bruera said. “It is given to almost all patients who die in the hospital and almost no patients in hospice.”

Bruera and colleagues randomly assigned 129 patients with cancer from six hospices to parenteral hydration to examine if the treatment improved dehydration, quality of life, and survival. Patients received either 1 L of normal saline hydration per day or placebo. The researchers compared the sum of fatigue, myoclonus, sedation, and hallucinations between baseline and day 4 of treatment.

“Our study found that giving water to all patients who decrease their fluid intake did not improve their symptoms,” Bruera said.

Results indicated that there was no significant difference between patients given hydration and those given placebo for the sum of the four dehydration symptoms examined, with both groups reporting significant improvements.

Those patients assigned to hydration had improvements in hallucinations (P = .002) and myoclunus (P = .01) compared with baseline. Patients assigned to placebo had improvements in pain (P = .02), depression (P = .04), anxiety (P = .002), and myoclonus (P = .03) compared with baseline.

No difference in overall survival was seen between the two groups with patients assigned hydration surviving a median of 21 days compared with 15 days for patients assigned placebo.

In their discussion of the results, the researchers addressed the concern that one reason for a lack of difference between the study groups was that the level of hydration was too low. They wrote that the “volume was specifically chosen based on our understanding that terminally ill patients with cancer require lower hydration volume as a result of weight loss, decreased insensible losses, decreased clearance of free water and advanced age.”

“It is possible that some groups of patients may benefit from hydration at home, but giving water to all hospice patients as is currently done in the hospital, is not appropriate, according to our study,” Bruera said.