TY - JOUR
T1 - Guidelines on artificial nutrition versus hydration in terminal cancer patients
AU - Bozzetti, Federico
AU - Amadori, Dino
AU - Bruera, Eduardo
AU - Cozzaglio, Luca
AU - Corli, Oscar
AU - Filiberti, Antonio
AU - Rapin, Charles Henri
AU - Neuenschwander, Hans
AU - Aoun, Michel
AU - Ricci, Sante Basso
AU - De Conno, Franco
AU - Doci, Roberto
AU - Garrone, Mariuccia
AU - Gentilini, Mara
AU - Lery, Nicole
AU - Mantell, Mark
AU - Sheldon-Collins, Rae
AU - Trompino, Giuseppe
N1 - Funding Information:
Supported by the Consiglio Nazionale per la Ricerca (C.N.R.), Grant Number 93.02345.PF 39 (ACRO 93), Milan, Italy.
PY - 1996/3
Y1 - 1996/3
N2 - Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision: Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.
AB - Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision: Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.
KW - hydration
KW - palliative care
KW - parenteral nutrition
KW - terminal cancer
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U2 - 10.1016/S0899-9007(96)91120-X
DO - 10.1016/S0899-9007(96)91120-X
M3 - Article
C2 - 8798219
AN - SCOPUS:0030110912
SN - 0899-9007
VL - 12
SP - 163
EP - 167
JO - Nutrition
JF - Nutrition
IS - 3
ER -