NEW YORK (Reuters Health) – Parenteral hydration offers virtually no benefit to hospice patients with advanced cancer.
There are no established standards for hydration at the end of life. The only randomized controlled study suggested that parenteral hydration decreased some symptoms associated with dehydration, and retrospective studies have suggested it can reduce sedation, hallucinations, myoclonus, and fatigue.
Dr. Eduardo Bruera from The University of Texas MD Anderson Cancer Center, Houston, and colleagues investigated whether parenteral hydration (normal saline 1 L per day) was superior to placebo (normal saline 100 mL per day) in 129 patients with advanced cancer receiving hospice care. Specifically, they wanted to know if it would it improve symptoms associated with dehydration, delay the onset and/or severity of delirium, and affect quality of life and survival.
By day four, patients in both groups showed significant improvements in overall dehydration symptoms, but there were no significant differences between the groups. By day seven, there was no significant improvement in overall dehydration symptoms from baseline in either group.
Most patients in both groups reported improvement on their global symptom evaluation from baseline to days four and seven. The improvements did not differ between the hydration and placebo groups.
Delirium measures worsened significantly from baseline in both groups, but the deterioration tended to be less for the hydration group than for the placebo group. Night-time delirium worsened to a significantly greater extent in the placebo group.
Quality of life scores improved in both groups, but again, there was no significant difference between the groups in the extent of improvement from baseline.
Median survival did not differ significantly between the hydration and the placebo groups (21 vs 15 days; p=0.83).
“One concern regarding the lack of observed difference between groups is that the volume of hydration may have been too low,” the researchers note. “Another limitation of this study is the fact that we excluded patients with severe dehydration (e.g., hemodynamic instability, altered mentation) because these individuals tend to be acutely ill and in severe distress, making it difficult to obtain informed consent, deliver the study interventions, and keep them on study.”
The study was also underpowered. The planned sample size was 150 patients, but funding issues required termination of the study after 129 patients.
“Our study supports current hospice practice of not administering hydration routinely,” the investigators conclude. “Further studies are required to determine whether any subgroups, such as delirious patients or those with longer survival, would benefit from parenteral hydration.”
Dr. Bruera did not respond to a request for comments.
