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The last days of life

symptom burden and impact on nutrition and hydration in cancer patients

Hui, David; Dev, Rony; Bruera, Eduardo

Current Opinion in Supportive and Palliative Care: December 2015 - Volume 9 - Issue 4 - p 346–354
doi: 10.1097/SPC.0000000000000171
CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Florian Strasser

Purpose of review To examine the symptom burden in cancer patients during the last days of life, its impact on nutrition and hydration, and the role of artificial nutrition and hydration in the final days.

Recent findings During the last days of life, cancer patients often experience progressive functional decline and worsening symptom burden. Many symptoms such as anorexia-cachexia, dysphagia, and delirium could impair oral intake. These, coupled with refractory cachexia, contribute to persistent weight loss and decreased quality of life. Furthermore, the inability to eat/drink and body image changes can result in emotional distress for patients and caregivers. Clinicians caring for these individuals need to ensure longitudinal communication about goals of care, education about the natural process of dying, optimization of symptom management, and provide appropriate emotional support for patients and caregivers. There is a lack of evidence to support that artificial nutrition and hydration can improve outcomes during the last days of life. Artificial nutrition is not recommended because of its invasive nature, whereas artificial hydration may be considered on a case-by-case basis.

Summary This review highlights the need to conduct further research on symptom burden, nutrition, and hydration during the last days of life.

Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence to David Hui, MD, MSc, Department of Palliative Care & Rehabilitation Medicine Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1 713 606 3376; fax: +1 713 792 6092; e-mail:

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