Abstract
BackgroundHydration in advanced cancer is a controversial area; however, current hydration assessments methods are poorly developed. Bioelectrical impedance vector analysis (BIVA) is an accurate hydration tool; however its application in advanced cancer has not been explored. This study used BIVA to evaluate hydration status in advanced cancer to examine the association of fluid status with symptoms, physical signs, renal biochemical measures and survival.Materials and methodsAn observational study of 90 adults with advanced cancer receiving care in a UK specialist palliative care inpatient unit was conducted. Hydration status was assessed using BIVA in addition to assessments of symptoms, physical signs, performance status, renal biochemical measures, oral fluid intake and medications. The association of clinical variables with hydration was evaluated using regression analysis. A survival analysis was conducted to examine the influence of hydration status and renal failure.ResultsThe hydration status of participants was normal in 43 (47.8%), 'more hydrated' in 37 (41.1%) and 'less hydrated' in 10 (11.1%). Lower hydration was associated with increased symptom intensity (Beta = -0.29, p = 0.04) and higher scores for physical signs associated with dehydration (Beta = 10.94, p = 0.02). Higher hydration was associated with oedema (Beta = 2.55, p<0.001). Median survival was statistically significantly shorter in 'less hydrated' patients (44 vs. 68 days; p = 0.049) and in pre-renal failure (44 vs. 100 days; p = 0.003).ConclusionsIn advanced cancer, hydration status was associated with clinical signs and symptoms. Hydration status and pre-renal failure were independent predictors of survival. Further studies can establish the utility of BIVA as a standardised hydration assessment tool and explore its potential research application, in order to inform the clinical management of fluid balance in patients with advanced cancer.
Highlights
People with advanced cancer commonly experience reduced oral intake in the last days of life. [1] This may cause healthcare professionals and family caregivers to question whether clinically assisted hydration (CAH) is required for the management of hydration status and symptoms
Lower hydration was associated with increased symptom intensity (Beta = -0.29, p = 0.04) and higher scores for physical signs associated with dehydration (Beta = 10.94, p = 0.02)
Hydration status was associated with clinical signs and symptoms
Summary
People with advanced cancer commonly experience reduced oral intake in the last days of life. [1] This may cause healthcare professionals and family caregivers to question whether clinically assisted hydration (CAH) is required for the management of hydration status and symptoms. There is limited evidence to determine the association between hydration and symptoms in advanced cancer.[2] Physical examination has low sensitivity and specificity for identifying fluid deficit.[2, 3] The evidence for the use and effects of CAH in advanced cancer is limited, conflicting and inconclusive.[2, 4, 5]. Bioelectrical impedance analysis (BIA) is a non-invasive body composition assessment tool based on the flow of electrical current through the body.[6] The recorded measurements include: resistance (R—the restriction to the flow of electrical current through the body, primarily related to the amount of water present in tissue) and reactance (Xc—resistive effect produced by the tissue interfaces and cell membranes). This study used BIVA to evaluate hydration status in advanced cancer to examine the association of fluid status with symptoms, physical signs, renal biochemical measures and survival
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