I originally started this blog to provide some straight talk to readers on common issues that people encounter at the end of life. There is perhaps no more common a question that that posed by this reader, below.
Dear Deadly,
My uncle was recently admitted to hospital (as an aside, I’m not sure why the medical establishment continues to use the word “admitted” to hospital, as if it were a concert or hockey game … but I digress) and there were some lively discussions amongst family members regarding whether or not to give him IV fluids. He has lung cancer, and over the past couple of weeks has barely been eating or drinking anything. He couldn’t even stand up and so we brought him to the hospital. My sisters wanted to give him IV fluid. I objected, feeling that if he was too weak to swallow, that he was close to the end.
Is this a case of more fluids, more problems?
Sincerely,
Wanting a True Expert Recommendation
Welcome to the blog! Your question is a common one. In other words, does giving IV fluid improve quality of life, prolong survival, prevent medical problems or improve any symptoms in patients with very advanced cancer? Probably not.
The Evidence for Fluids at the End of Life
There was a fascinating study done with 129 patients across 5 hospices in the Greater Houston Texas area back in 2007. People with advanced cancer in hospice were included in the study. They either got half a cup of fluid per day (i.e., placebo) or 1 L of fluid per day via IV, and we were checked again in about a week with regard to their overall survival, fatigue, and any dehydration symptoms. The bottom line was that In this frail group of patients, who had a median survival of 17 days, there was no difference in survival between patients that received extra fluid and those that didn’t. IV fluids did not improve any symptoms associated with dehydration, either.
The Bottom Line
The bottom line is that a low fluid intake is the consequence of cancer progression – not the other way around.
What should you do? In general, taking sips of fluid as tolerated is fine, and if your loved one is unable to take fluid any longer, this probably means that they are getting sicker. More fluids beyond what they prefer to comfortably take won’t speed their recovery, and is unlikely to improve their symptoms.
More Water = More problems?
Finally, one last word of caution: fluids can cause real harm if used inappropriately. For patients that have swelling in their arms or legs, or patients that have heart disorders (e.g., heart failure), extra fluids can worsen swelling and symptoms, and can also contribute to difficulty with breathing.
Indeed sometimes it is a case of more water, more problems. I hope this helps.