The last days of life: symptom burden and impact on nutrition and hydration in cancer patients.
OBJECTIVE
To examine the symptom burden in cancer patients during the last days of life, its impact on nutrition and hydration, and the role of artificial nutrition and hydration in the final days.


RESULTS
During the last days of life, cancer patients often experience progressive functional decline and worsening symptom burden. Many symptoms such as anorexia-cachexia, dysphagia, and delirium could impair oral intake. These, coupled with refractory cachexia, contribute to persistent weight loss and decreased quality of life. Furthermore, the inability to eat/drink and body image changes can result in emotional distress for patients and caregivers. Clinicians caring for these individuals need to ensure longitudinal communication about goals of care, education about the natural process of dying, optimization of symptom management, and provide appropriate emotional support for patients and caregivers. There is a lack of evidence to support that artificial nutrition and hydration can improve outcomes during the last days of life. Artificial nutrition is not recommended because of its invasive nature, whereas artificial hydration may be considered on a case-by-case basis.


CONCLUSIONS
This review highlights the need to conduct further research on symptom burden, nutrition, and hydration during the last days of life.
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
David
D
Hui
Rony
R
Dev
Eduardo
E
Bruera
D002100:Cachexia / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D003142:Communication; D003643:Death; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D010347:Patient Care Planning; D010353:Patient Education as Topic; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods*