Hydration in Advanced Cancer: Can Bioelectrical Impedance Analysis Improve the Evidence Base? A Systematic Review of the Literature

• Published in: Journal of pain and symptom management 2013-09, Vol.46 (3), p.433-446.e6
• Main Authors: Nwosu, Amara Callistus, MBChB, MRCP, Mayland, Catriona R., MBChB, MD, FRCP, Mason, Stephen R., PhD, PGCE, BA, Khodabukus, Andrew F., MBChB, BSc, MRCP, Varro, Andrea, PhD, MD, Ellershaw, John E., MB BCh, MA, FRCP
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Assessment; Bioelectrical impedance; bioelectrical impedance analysis; Biological and medical sciences; Cancer; Cardiography, Impedance - methods; Cardiography, Impedance - statistics & numerical data; Causality; clinically assisted hydration; Comorbidity; dehydration; Dehydration - epidemiology; Dehydration - nursing; Dying people; Evidence-Based Medicine; Fluid Therapy - utilization; Humans; Hydration; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - nursing; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Pain Medicine; Palliative care; Pharmacology. Drug treatments; Reproducibility of Results; Sensitivity and Specificity; Terminally ill people; Treatment Outcome; Tumors
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2012.08.018

Abstract Context Decisions surrounding the administration of clinically assisted hydration to patients dying of cancer can be challenging because of the limited understanding of hydration in advanced cancer and a lack of evidence to guide health care professionals. Bioelectrical impedance analysis (BIA) has been used to assess hydration in various patient groupings, but evidence for its use in advanced cancer is limited. Objectives To critically appraise existing methods of hydration status assessment in advanced cancer and review the potential for BIA to assess hydration in advanced cancer. Methods Searches were carried out in four electronic databases. A hand search of selected peer-reviewed journals and conference abstracts also was conducted. Studies reporting (de)hydration assessment (physical examination, biochemical measures, symptom assessment, and BIA) in patients with advanced cancer were included. Results The results highlight how clinical examination and biochemical tests are standard methods of assessing hydration, but limitations exist with these methods in advanced cancer. Furthermore, there is disagreement over the evidence for some commonly associated symptoms with dehydration in cancer. Although there are limitations with using BIA alone to assess hydration in advanced cancer, analysis of BIA raw measurements through the method of bioelectrical impedance vector analysis may have a role in this population. Conclusion The benefits and burdens of providing clinically assisted hydration to patients dying of cancer are unclear. Bioelectrical impedance vector analysis shows promise as a hydration assessment tool but requires further study in advanced cancer. Innovative methodologies for research are required to add to the evidence base and ultimately improve the care for the dying.