Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

• Published in: BMC palliative care 2024-08, Vol.23 (1), p.209-18
• Main Authors: Nwosu, Amara Callistus, Stanley, Sarah, Mayland, Catriona R, Mason, Stephen, McDougall, Alexandra, Ellershaw, John E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Bioelectrical impedance analysis; Body composition; Body Composition - physiology; Body Water; Cancer; Clinical outcomes; Clinically assisted hydration; Consent; Decision making; Dehydration; Dehydration (Physiology); Dehydration - diagnosis; Dehydration - physiopathology; Diagnosis; Drinking (Physiology); Electric currents; Electric Impedance; Electrolytes; Ethnicity; Evidence-based medicine; Female; Humans; Hydration; Illnesses; Male; Medical care; Medical personnel; Middle Aged; Neoplasms - complications; Neoplasms - psychology; Observational studies; Oncology, Experimental; Organism Hydration Status - physiology; Palliative care; Palliative treatment; Prospective Studies; Quality management; Quality of Life - psychology
• ISSN: 1472-684X; 1472-684X
• 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