title: Guidelines for parenteral fluid management for terminal cancer patients.
abstract: BACKGROUND
  Japan's first guidelines for parenteral fluid management for terminal cancer patients were issued in 2006. These guidelines focused on the fluid levels to administer to patients with a remaining life expectancy of 1-2 months. However, recent refinement of the concept of cachexia is prompting caregivers worldwide to rethink parenteral fluid management for terminal cancer patients.
  
  
  OBJECTIVE
  Our objective was to develop guidelines for parenteral fluid management for terminal cancer patients with a remaining life expectancy of 1 month, a point when cachexia generally begins to severely adversely affect the body.
  
  
  METHODS
  The Japanese Society for Palliative Medicine appointed a Guidelines Working Practitioner Group consisting of a multidisciplinary team of specialists. In response to 26 clinical questions on parenteral fluid management for terminal cancer patients, the Working Group used the Delphi method to reach consensus on the recommendability and evidence level of 89 relevant manuscripts identified through a systematic literature review. The Working Group then had an outside committee reviews the draft guidelines validity before authoring the final version.
  
  
  RESULTS
  The resulting clinically aligned guidelines contain specific recommendations (25 recommendations on physical suffering/remaining life expectancy, 10 nursing-related recommendations and 4 ethical recommendations) assessed using the Delphi method and by an outside committee.
  
  
  CONCLUSIONS
  Japanese Society for Palliative Medicine released a revised edition of the Guidelines for Parenteral Fluid Management for Terminal Cancer Patients, which are based on medical evidence and consider the pathologic features of cachexia. We recommend that caregivers carefully evaluate the clinical usefulness of the guidelines.
authors: Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Aichi.
authors: Takashi
authors: T
authors: Higashiguchi
authors: Department of Pain Medicine, Palliative Care Hyogo Cancer Center, Akashi-City, Hyogo.
authors: Junichi
authors: J
authors: Ikegaki
authors: Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors: Kazuya
authors: K
authors: Sobue
authors: Palliative Medicine Yamanote Hospital, Ibaraki.
authors: Yoichiro
authors: Y
authors: Tamura
authors: Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Miyagi.
authors: Nobuhisa
authors: N
authors: Nakajima
authors: Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Mie.
authors: Akihiko
authors: A
authors: Futamura
authors: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi.
authors: Mitsunori
authors: M
authors: Miyashita
authors: Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Aichi.
authors: Naoharu
authors: N
authors: Mori
authors: Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical & Dental Sciences, Kagoshima.
authors: Akio
authors: A
authors: Inui
authors: Department of Surgery, Nippon Medical School, Tokyo.
authors: Keiichiro
authors: K
authors: Ohta
authors: Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Toyoshi
authors: T
authors: Hosokawa
keywords: artificial hydration; cachexia; palliative care; parenteral nutrition; quality of life