To hydrate or not to hydrate: How should it be?

Although the problem of inadequate fluid intake combined with recurrent progressive disease is common to all three cases, our first patient with advanced pancreatic carcinoma would probably feel that subcutaneous hydration at home is indicated. For Mr B, intravenous fluids: in the hospital seem to be a better approach, and for Mrs C, minimal oral intake and mouth care at home seem appropriate. To conclude, decisions on hydration do not simply depend on biologic factors. Ethical considerations dictate that the patient, if competent, or a surrogate receive information on available options, including subcutaneous fluid administration. The information provided should enable the patient to make the decision that is appropriate for his or her current goals. The decision to hydrate or not to hydrate is not binary; time- limited trials are sensible if there is doubt about the wisdom of instituting hydration. In any event, the profound psychologic importance of the decision on patient and family is such that the oncologist should carefully observe the patient and family and offer continued counsel.