A new study, led by researchers from Royal Surrey County Hospital NHS Foundation Trust and the University of Surrey, suggests clinically assisted hydration at the end-of-life extends survival in cancer patients.
Over a 1-year period, the cluster randomised trial recruited 200 patients with cancer in the last week of life who were unable to maintain sufficient oral fluid intake. The participants, who were recruited from 12 sites with specialist palliative care teams, were randomised on a one-to-one basis to intervention A (regular mouth care and usual other care) or intervention B (clinically assisted hydration, mouth care and usual other care).
End-of-life patients receiving assisted hydration had a 26% greater survival, translating to an average of 1.5 additional days of life. Patients receiving fluids were also found to have good symptom control, and suffer minimal side effects. Just over 38.5% of participants discontinued clinically assisted hydration due to adverse effects. None of these adverse events were rated as severe or worse in intensity. Primary reasons for discontinuation were site problems, localised oedema, generalised oedema, respiratory secretions, and nausea and vomiting.
"The provision of clinically assisted hydration at the end-of-life is one of the most contentious issues in medicine,” said co-author, Dr. Andrew Davies, a consultant in palliative medicine at Royal Surrey County Hospital. "The results of this study are certainly interesting, but a larger study is needed to confirm the role of clinically assisted hydration at the end of life."
"For some patients and their families living an extra day or so may be extremely important, as it can give them an opportunity to say their goodbyes, have family arrive from abroad, write a will or even get married,” he pointed out.
A further study is now planned to continue to evaluate the role that providing fluids plays in end-of-life care.
