Lancaster Medical School, Lancaster University, Lancaster, UK.
Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
BMC Palliat Care. 2024 Aug 19;23(1):209. doi: 10.1186/s12904-024-01542-z.
Oral fluid intake decreases in advanced cancer in the dying phase of illness. There is inadequate evidence to support the assessment, and management, of hydration in the dying. Bioelectrical impedance analysis (BIA) is a body composition assessment tool. BIA has the potential to inform clinal management in advanced cancer, by examining the relationships between hydration status and clinical variables.
BIA was used to determine the association between hydration status, symptoms, clinical signs, quality-of-life and survival in advanced cancer, including those who are dying (i.e. in the last week of life).
We conducted a prospective observational study of people with advanced cancer in three centres. Advance consent methodology was used to conduct hydration assessments in the dying. Total body water was estimated using the BIA Impedance index (Height - H (m) /Resistance - R (Ohms)). Backward regression was used to identify factors (physical signs, symptoms, quality of life) that predicted H/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes.
One hundred and twenty-five people participated (males n = 74 (59.2%), females, n = 51 (40.8%)). We used backward regression analysis to describe a statistical model to predict hydration status in advanced cancer. The model demonstrated that 'less hydration' (lower H/R) was associated with female sex (Beta = -0.39, p < 0.001), increased appetite (Beta = -0.12, p = 0.09), increased dehydration assessment scale score (dry mouth, dry axilla, sunken eyes - Beta = -0.19, p = 0.006), and increased breathlessness (Beta = -0.15, p = 0.03). 'More hydration' (higher H/R) was associated with oedema (Beta = 0.49, p < 0.001). In dying participants (n = 18, 14.4%), hydration status (H/R) was not significantly different compared to their baseline measurements (n = 18, M = 49.6, SD = 16.0 vs. M = 51.0, SD = 12.1; t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (r = -0.85, p = 0.74), pain (r = 0.31, p = 0.23) or respiratory tract secretions (r = -0.34, p = 0.19).
This is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. Our data demonstrates the feasibility of using an advance consent method to conduct research in dying people. This method can potentially improve the evidence base (and hence, quality of care) for the dying. Future BIA research can involve hydration assessment of cancers (according to type and stage) and associated variables (e.g., stage of illness, ethnicity and gender). Further work can use BIA to identify clinically relevant outcomes for hydration studies and establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer.
在癌症晚期临终阶段，患者的口腔液体摄入量会减少。目前尚缺乏充分的证据来支持对临终患者的液体摄入情况进行评估和管理。生物电阻抗分析（BIA）是一种身体成分评估工具。通过检查液体摄入状态与临床变量之间的关系，BIA 有可能为晚期癌症的临床管理提供信息。
本研究旨在使用 BIA 评估晚期癌症患者（包括临终患者）的液体摄入状态与症状、临床体征、生活质量和生存之间的关系。
我们在三个中心进行了一项前瞻性观察性研究。采用预先同意的方法对临终患者进行液体摄入评估。使用 BIA 阻抗指数（身高 - H（m）/电阻 - R（欧姆））估计总体水。采用向后回归分析来确定预测 H/R 的因素（物理体征、症状、生活质量）。在临终前 7 天的患者中进一步进行 BIA 评估，以评估液体摄入变化及其与临床结局的关系。
共有 125 名患者参与（男性 n=74（59.2%），女性 n=51（40.8%））。我们采用向后回归分析描述了一个预测晚期癌症患者液体摄入状态的统计模型。该模型表明，“液体摄入不足”（较低的 H/R）与女性性别（β=-0.39，p<0.001）、食欲增加（β=-0.12，p=0.09）、脱水评估量表评分增加（口干、腋窝干燥、眼睛凹陷-β=-0.19，p=0.006）和呼吸急促（β=-0.15，p=0.03）有关。“液体摄入过多”（较高的 H/R）与水肿有关（β=0.49，p<0.001）。在临终患者（n=18，14.4%）中，与基线测量相比，其液体摄入状态（H/R）没有显著差异（n=18，M=49.6，SD=16.0 vs. M=51.0，SD=12.1；t（17）=0.64，p=0.53），也与激越（r=-0.85，p=0.74）、疼痛（r=0.31，p=0.23）或呼吸道分泌物（r=-0.34，p=0.19）无关。
这是第一项使用生物阻抗法报告模型（使用临床因素）来预测晚期癌症患者液体摄入状态的研究。我们的数据表明，使用预先同意方法在临终患者中进行研究是可行的。这种方法有可能改善临终患者的护理质量。未来的 BIA 研究可以涉及不同类型和阶段癌症患者的液体摄入评估以及相关变量（例如疾病阶段、种族和性别）。进一步的研究可以使用 BIA 来确定与液体摄入相关的临床相关结局，并建立一个核心结局集，以评估液体摄入对癌症患者症状和生活质量的影响。
