Guidelines on artificial nutrition versus hydration in terminal cancer patients

被引:92
作者
Bozzetti, F
机构
[1] UNITA SANIT LOCALE 38,FORLI,ITALY
[2] EDMONTON GEN HOSP,EDMONTON,AB,CANADA
[3] IST NAZL TUMORI,MILAN,ITALY
[4] OSPED BUZZI,MILAN,ITALY
[5] EUROPEAN INST ONCOL,MILAN,ITALY
[6] POLIGERS RIVEGAUCHE,GENEVA,SWITZERLAND
[7] OSPED REG LUGANO,LUGANO,SWITZERLAND
[8] INST JULES BORDET,B-1000 BRUSSELS,BELGIUM
[9] IST NEUROCHIRURG C BESTA,MILAN,ITALY
[10] HOP EDOUARD HERRIOT,LYON,FRANCE
[11] UNIV PENN,PHILADELPHIA,PA 19104
[12] IST NAZL TUMORI,I-20133 MILAN,ITALY
关键词
parenteral nutrition; hydration; terminal cancer; palliative care;
D O I
10.1016/S0899-9007(96)91120-X
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision; Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.
引用
收藏
页码:163 / 167
页数:5
相关论文
共 27 条
[1]  
Baines M, 1988, J Pain Symptom Manage, V3, P81, DOI 10.1016/0885-3924(88)90165-0
[2]  
BALZOLA F, 1992, RIV ITALIANA NUTR PA, V2, P93
[4]  
Brescia F J, 1990, J Pain Symptom Manage, V5, P221, DOI 10.1016/0885-3924(90)90015-C
[5]   ESTIMATE OF SURVIVAL OF PATIENTS ADMITTED TO A PALLIATIVE CARE UNIT - A PROSPECTIVE-STUDY [J].
BRUERA, E ;
MILLER, MJ ;
KUEHN, N ;
MACEACHERN, T ;
HANSON, J .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1992, 7 (02) :82-86
[6]  
BURGE FI, 1990, CAN FAM PHYSICIAN, V36, P883
[7]   DEHYDRATION SYMPTOMS OF PALLIATIVE CARE CANCER-PATIENTS [J].
BURGE, FI .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1993, 8 (07) :454-464
[8]   A COST-UTILITY ANALYSIS OF THE HOME PARENTERAL-NUTRITION PROGRAM AT TORONTO-GENERAL-HOSPITAL - 1970-1982 [J].
DETSKY, AS ;
MCLAUGHLIN, JR ;
ABRAMS, HB ;
WHITTAKER, JS ;
WHITWELL, J ;
LABBE, K ;
JEEJEEBHOY, KN .
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, 1986, 10 (01) :49-57
[9]  
EVANS C, 1985, LANCET, V1, P1204
[10]   THE USE OF HYPODERMOCLYSIS FOR REHYDRATION IN TERMINALLY ILL CANCER-PATIENTS [J].
FAINSINGER, RL ;
MACEACHERN, T ;
MILLER, MJ ;
BRUERA, E ;
SPACHYNSKI, K ;
KUEHN, N ;
HANSON, J .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1994, 9 (05) :298-302