Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer: a population-based register study

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Lindskog, MagnusDepartment of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Solna, Sweden; Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden (author)

Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer : a population-based register study

Article/chapterEnglish2024

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BioMed Central (BMC),2024
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LIBRIS-ID:oai:DiVA.org:umu-228044
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-228044URI
https://doi.org/10.1186/s12904-024-01504-5DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Background: Parenteral fluid (PF) therapy of patients in end-of-life (EOL) is controversial. The purpose of this study was to assess associations between PF, quality of the EOL care process and symptom burden in dying cancer patients, using a population-based approach.Methods: This was a nationwide retrospective register study of all adult cancer deaths with documented information on PF in the last 24 h of life as reported to the Swedish Register of Palliative Care during a three-year period (n = 41,709). Prevalence and relief of symptoms during the last week of life as well as EOL care process quality indicators were assessed in relation to PF in those patients who had a documented decision to focus on EOL care (immediately dying, n = 23,112). Odds ratios were calculated, adjusting for place of death (hospital vs. non-hospital).Results: PF was administered to 30.9% of immediately dying patients in hospitals compared to 6.5% outside of hospitals. PF was associated with a higher likelihood for breathlessness and nausea. In patients screened for EOL symptoms with a validated instrument, PF was inversely associated with the likelihood of complete relief of breathlessness, respiratory secretions, anxiety, nausea and pain. Several palliative care quality indicators were inversely associated with PF, including EOL conversations and prescriptions of injectable drugs as needed. These associations were more pronounced in hospitals.Conclusions: Parenteral fluid therapy in the last 24 h of life was associated with inferior quality of the EOL care process and with increased symptom burden in imminently dying cancer patients.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Omvårdnad hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Nursing hsv//eng
Cancer
End-of-life
Fluid therapy
Palliative care
Quality
Symptoms

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Mogensen, HannaDepartment of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (author)
Tavelin, BjörnUmeå universitet,Institutionen för strålningsvetenskaper(Swepub:umu)bjta0001 (author)
Eknert, JohannaUpper GI Unit, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden (author)
Lundström, StaffanStockholms Sjukhem Foundation and Department of Oncology-Pathology, Stockholm, Sweden (author)
Strang, PeterStockholms Sjukhem Foundation and Department of Oncology-Pathology, Stockholm, Sweden (author)
Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Solna, Sweden; Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, SwedenDepartment of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (creator_code:org_t)

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In:BMC Palliative Care: BioMed Central (BMC)23:11472-684X

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By the author/editor: Lindskog, Magnus; Mogensen, Hanna; Tavelin, Björn; Eknert, Johanna; Lundström, Staff ...; Strang, Peter

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cancer and Oncol ...

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