title: Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health; Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands. Electronic address: n.raijmakers@erasmusmc.nl.
authors.forename: N J H
authors.initials: NJH
authors.lastname: Raijmakers
authors.affiliation: Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Zuylen
authors.affiliation: Department of Regional Palliative Care Network, National Cancer Research Institute, Genoa.
authors.forename: M
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Palliative Care Pain, Therapy and Rehabilitation, National Cancer Institute, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caraceni
authors.affiliation: Education and Research Unit, Arohanui Hospice, Palmerston North, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.affiliation: Department of Palliative Home Care, Ludvika, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Lundquist
authors.affiliation: Department of Palliative Medicine; Center for Integrated Oncology Cologne/Bonn, University Hospital of Cologne, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Voltz
authors.affiliation: Marie Curie Palliative Care Institute, University of Liverpool, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Ellershaw
authors.affiliation: Department of Public Health.
authors.forename: A
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D005440:Fluid Therapy; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D018529:Nutritional Support; D010342:Patient Acceptance of Health Care; D013727:Terminal Care