Medically assisted hydration to assist palliative care patients

Good P, Cavenagh J, Mather M, Ravenscroft P

Published Online:

March 16, 2011

This review is an updated version of the original Cochrane review published in Issue 2, 2008, there has been no change to the conclusions since the first version was published. It is common for palliative care patients to have reduced fluid intake during their illness. Management of this condition includes discussion with the patient, family and staff involved and may include the provision of fluids with medical assistance. This can be performed using a small plastic tube inserted into a vein or subcutaneous tissue, or via a tube inserted into the stomach. It is unknown whether this treatment helps people to feel better or live longer. A search of the international literature was only able to find a small number of studies looking at this issue. As a result, it is not possible to clearly define the benefits and harms of this treatment.

Abstract (click to read)

Background:

Many palliative care patients have reduced oral intake during their illness. The management of this can include the provision of medically assisted hydration with the aim of prolonging the length of life of a patient, improving their quality of life, or both. This is an updated version of the original Cochrane review published in Issue 2, 2008.

Objectives:

To determine the effect of medically assisted hydration in palliative care patients on their quality and length of life.

Search strategy:

Studies were identified from searching CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, Caresearch, Dissertation abstracts, SCIENCE CITATION INDEX and the reference lists of all eligible studies, key textbooks, and previous systematic reviews. The date of the latest search conducted on EMBASE, CENTRAL and MEDLINE was November 2010.

Selection criteria:

All relevant randomised controlled trials (RCTs) or prospective controlled studies of medically assisted hydration in palliative care patients.

Data collection and analysis:

Five relevant studies were identified. These included two RCTs (93 participants), and three prospective controlled trials (360 participants). These were assessed independently by two review authors for quality and validity. The small number of studies and the heterogeneity of the data meant that a quantitative analysis was not possible, so a description of the main findings was included only.

Main results:

One study found that sedation and myoclonus (involuntary contractions of muscles) were improved more in the intervention group (28 - hydration, 23 - placebo). Another study found that dehydration was significantly higher in the non-hydration group, but that some fluid retention symptoms (pleural effusion, peripheral oedema and ascites) were significantly higher in the hydration group (59 - hydration group, 167 - non -hydration group). The other three studies did not show significant differences in outcomes between the two groups.

Authors' conclusions:

Since the last version of this review no new studies were found. However there is one ongoing, high quality study that has not reached full recruitment. There are insufficient good quality studies to make any recommendations for practice with regard to the use of medically assisted hydration in palliative care patients.

This record should be cited as:

Good P, Cavenagh J, Mather M, Ravenscroft P. Medically assisted hydration for adult palliative care patients. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006273. DOI: 10.1002/14651858.CD006273.pub2

Assessed as up to date:

February 14, 2011

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Cancer > Palliative and supportive care > Hydration and nutrition

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Medically assisted hydration to assist palliative care patients

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