Hydration in palliative care: when, how and why

Background: a great majority of patients with end-stage disease experience a severily reduced oral intake before death, which is due to a variety of causes related to their cancer or its treatment. Reduced oral intake is perceived by patients and their families with distress because of implications related to eating and hydration. This perception and the fact that there is no evidence-based research to determine how it is best to proceed sourround this issue of much controversy even among palliative care professionals. Objective: to review the existing literature regarding the assessment of hydration in cancer patients, the process of decision making regarding hydration, and the methods and outcomes of artificial hydration. Material and method: we conducted a narrative review using the Pub-med database as well as references within the identified papers, chapters in textbooks of pallaitive medicine and oncology, and previous issues of Medicina Paliativa. The review was conducted both in English and Spanish. Results: terminal cancer patients need less fluid for adequate hydration; however, they are at increased risk for fluid deficiency, often precipitated by minor variations in fluid intake, infection, and other conditions. Conclusion: the main symptoms of dehydration are difficult to interpret due to the presence of multiple symptoms related to cancer and cancer therapy. A careful assessment is needed before a decision is made regarding fluid administration. In unclear cases a brief trial of parenteral hydration may be useful. The subcutaneous and rectal routes are useful alternatives to the intravenous route, particularly in the community setting. If hydration is not considered appropriate a progressive reduction of drugs likely to accumulate in the presence of dehydration - including opioids - is indicated.