Effects of parenteral hydration in terminally ill cancer patients: a preliminary study.
OBJECTIVE
Most patients with cancer develop decreased oral intake and dehydration before death. This study aimed to determine the effect of parenteral hydration on overall symptom control in terminally ill cancer patients with dehydration.


METHODS
Patients with clinical evidence of mild to moderate dehydration and a liquid oral intake less than 1,000 mL/day were randomly assigned to receive either parenteral hydration with 1,000 mL (treatment group) or placebo with 100 mL normal saline administered over 4 hours for 2 days. Patients were evaluated for target symptoms (hallucinations, myoclonus, fatigue, and sedation), global well-being, and overall benefit.


RESULTS
Twenty-seven patients randomly assigned to the treatment group had improvement in 53 (73%) of their 73 target symptoms versus 33 (49%) of 67 target symptoms in the placebo group (n=22; P = .005). Fifteen (83%) of 18 and 15 (83%) of 18 patients had improved myoclonus and sedation after hydration versus eight (47%) of 17 and five (33%) of 15 patients after placebo (P = .035 and P = .005, respectively). There were no significant differences of improvement in hallucinations or fatigue between groups. When blinded to treatment, patients (17 [63%] of 77) and investigators (20 [74%] of 27) perceived hydration as effective compared with placebo in nine (41%) of 22 patients (P = .78) and 12 (54%) of 22 investigators (P = .15), respectively. The intensity of pain and swelling at the injection site were not significantly different between groups.


CONCLUSIONS
Parenteral hydration decreased symptoms of dehydration in terminally ill cancer patients who had decreased fluid intake. Hydration was well tolerated, and a placebo effect was observed. Studies with larger samples and a longer follow-up period are justified.
Bruera
Eduardo
E
Department of Palliative Care and Rehabilitation Medicine, Unit 8, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. ebruera@mdanderson.org
Sala
Raul
R
Rico
Maria Antonieta
MA
Moyano
Jairo
J
Centeno
Carlos
C
Willey
Jie
J
Palmer
J Lynn
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003681:Dehydration / Q000628:therapy*; D004311:Double-Blind Method; D005221:Fatigue; D005260:Female; D005440:Fluid Therapy; D006212:Hallucinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010288:Parenteral Nutrition; D010919:Placebos; D011788:Quality of Life; D012720:Severity of Illness Index; D012965:Sodium Chloride; D013727:Terminal Care
D010919:Placebos; D012965:Sodium Chloride