Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process

Chien-Yi Wu, Ping-Jen Chen, Shao-Yi Cheng, Sang-Yeon Suh, Hsien-Liang Huang, Wen-Yuan Lin, Yusuke Hiratsuka, Sun-Hyun Kim, Takashi Yamaguchi, Tatsuya Morita, Satoru Tsuneto, Masanori Mori, EASED Investigators, Chien-Yi Wu, Ping-Jen Chen, Shao-Yi Cheng, Sang-Yeon Suh, Hsien-Liang Huang, Wen-Yuan Lin, Yusuke Hiratsuka, Sun-Hyun Kim, Takashi Yamaguchi, Tatsuya Morita, Satoru Tsuneto, Masanori Mori, EASED Investigators

Abstract

Background: Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD.

Methods: This study is part of the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250-mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD.

Results: In total, 1530 patients were included in the analysis. Country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH.

Conclusions: AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD.

Lay summary: Our prospective cross-cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer. The findings reveal that country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD). After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end-of-life stage and achieve a good death.

Keywords: artificial hydration; hospice; palliative care; quality of dying; terminally ill patients with cancer.

© 2022 American Cancer Society.

References

    1. Ganzini L. Artificial nutrition and hydration at the end of life: ethics and evidence. Palliat Support Care. 2006;4:135-143.
    1. Geppert CM, Andrews MR, Druyan ME. Ethical issues in artificial nutrition and hydration: a review. JPEN J Parenter Enteral Nutr. 2010;34:79-88.
    1. Bruera E, Sala R, Rico MA, et al. Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol. 2005;23:2366-2371.
    1. Nakajima N, Takahashi Y, Ishitani K. The volume of hydration in terminally ill cancer patients with hydration-related symptoms: a prospective study. J Palliat Med. 2014;17:1037-1041.
    1. Bruera E, Hui D, Dalal S, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31:111-118.
    1. Morita T, Hyodo I, Yoshimi T, et al. Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol. 2005;16:640-647.
    1. Morita T, Hyodo I, Yoshimi T, et al. Artificial hydration therapy, laboratory findings, and fluid balance in terminally ill patients with abdominal malignancies. J Pain Symptom Manage. 2006;31:130-139.
    1. Nakajima N, Hata Y, Kusumuto K. A clinical study on the influence of hydration volume on the signs of terminally ill cancer patients with abdominal malignancies. J Palliat Med. 2013;16:185-189.
    1. Hui D, Dev R, Bruera E. The last days of life: symptom burden and impact on nutrition and hydration in cancer patients. Curr Opin Support Palliat Care. 2015;9:346-354.
    1. Mercadante S, Ferrera P, Girelli D, Casuccio A. Patients' and relatives' perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manage. 2005;30:354-358.
    1. Cohen MZ, Torres-Vigil I, Burbach BE, de la Rosa A, Bruera E. The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2012;43:855-865.
    1. Chiu TY, Hu WY, Chuang RB, Cheng YR, Chen CY, Wakai S. Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manage. 2004;27:206-214.
    1. Wu C-Y, Chen P-J, Ho T-L, Lin W-Y, Cheng S-Y. To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients. BMC Palliat Care. 2021;20:13.
    1. Torres-Vigil I, Cohen MZ, de la Rosa A, et al. Food or medicine: ethnic variations in perceptions of advanced cancer patients and their caregivers regarding artificial hydration during the last weeks of life. BMJ Support Palliat Care. 2012;2:276-279.
    1. Dev R, Dalal S, Bruera E. Is there a role for parenteral nutrition or hydration at the end of life? Curr Opin Support Palliat Care. 2012;6:365-370.
    1. Morita T, Oyama Y, Cheng SY, et al. Palliative care physicians' attitudes toward patient autonomy and a good death in East Asian countries. J Pain Symptom Manage. 2015;50:190-199.e191.
    1. Mak JM, Clinton M. Promoting a good death: an agenda for outcomes research-a review of the literature. Nurs Ethics. 1999;6:97-106.
    1. Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In search of a good death: observations of patients, families, and providers. Ann Intern Med. 2000;132:825-832.
    1. Vanderveken L, Schoenmakers B, De Lepeleire J. A better understanding of the concept “A Good Death”: how do healthcare providers define a good death? Am J Geriatr Psychiatry. 2019;27:463-471.
    1. Kastbom L, Milberg A, Karlsson M. A good death from the perspective of palliative cancer patients. Support Care Cancer. 2017;25:933-939.
    1. Krikorian A, Maldonado C, Pastrana T. Patient's perspectives on the notion of a good death: a systematic review of the literature. J Pain Symptom Manage. 2020;59:152-164.
    1. Sagha Zadeh R, Eshelman P, Setla J, Sadatsafavi H. Strategies to improve quality of life at the end of life: interdisciplinary team perspectives. Am J Hosp Palliat Care. 2018;35:411-416.
    1. Yamaguchi T, Maeda I, Hatano Y, et al. Communication and behavior of palliative care physicians of patients with cancer near end of life in three East Asian countries. J Pain Symptom Manage. 2021;61:315-322.e311.
    1. Chermesh I, Mashiach T, Amit A, et al. Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks? Med Oncol. 2011;28:83-88.
    1. Lokker ME, van der Heide A, Oldenmenger WH, van der Rijt CCD, van Zuylen L. Hydration and symptoms in the last days of life. BMJ Support Palliat Care. 2021;11:335.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.
    1. Cheng SY, Suh SY, Morita T, et al. A cross-cultural study on behaviors when death is approaching in East Asian countries: what are the physician-perceived common beliefs and practices? Medicine (Baltimore). 2015;94:e1573.
    1. Schildmann EK, Groeneveld EI, Denzel J, et al. Discovering the hidden benefits of cognitive interviewing in two languages: the first phase of a validation study of the Integrated Palliative Care Outcome Scale. Palliat Med. 2016;30:599-610.
    1. Sakurai H, Miyashita M, Imai K, et al. Validation of the Integrated Palliative Care Outcome Scale (IPOS)-Japanese version. Jpn J Clin Oncol. 2019;49:257-262.
    1. Frucht SJ, Leurgans SE, Hallett M, Fahn S. The Unified Myoclonus Rating Scale. Adv Neurol. 2002;89:361-376.
    1. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997;13:128-137.
    1. Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13:229-242.
    1. Back IN, Jenkins K, Blower A, Beckhelling J. A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle. Palliat Med. 2001;15:329-336.
    1. Yao CA, Hu WY, Lai YF, Cheng SY, Chen CY, Chiu TY. Does dying at home influence the good death of terminal cancer patients? J Pain Symptom Manage. 2007;34:497-504.
    1. Cheng SY, Hu WY, Liu WJ, Yao CA, Chen CY, Chiu TY. Good death study of elderly patients with terminal cancer in Taiwan. Palliat Med. 2008;22:626-632.
    1. Leung KK, Tsai JS, Cheng SY, et al. Can a good death and quality of life be achieved for patients with terminal cancer in a palliative care unit? J Palliat Med. 2010;13:1433-1438.
    1. Morita T, Miyashita M, Shibagaki M, et al. Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manage. 2006;31:306-316.
    1. National Clinical Guideline Centre (UK). Care of Dying Adults in the Last Days of Life. National Institute for Health and Care Excellence (NICE); 2015.
    1. Amano K, Morita T, Miyamoto J, Uno T, Katayama H, Tatara R. Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings. Support Care Cancer. 2018;26:2793-2799.
    1. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ. 2003;326:30-34.

Source: PubMed

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