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Nwosu AC, Stanley S, Mayland CR, Mason S, McDougall A, Ellershaw JE. 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. BMC Palliat Care 2024; 23:209. [PMID: 39160544 PMCID: PMC11331739 DOI: 10.1186/s12904-024-01542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND 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. AIM 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). MATERIALS AND METHODS 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)2 /Resistance - R (Ohms)). Backward regression was used to identify factors (physical signs, symptoms, quality of life) that predicted H2/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes. RESULTS 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 H2/R) was associated with female sex (Beta = -0.39, p < 0.001), increased appetite (Beta = -0.12, p = 0.09), increased dehydration assessment scale score (dry mouth, dry axilla, sunken eyes - Beta = -0.19, p = 0.006), and increased breathlessness (Beta = -0.15, p = 0.03). 'More hydration' (higher H2/R) was associated with oedema (Beta = 0.49, p < 0.001). In dying participants (n = 18, 14.4%), hydration status (H2/R) was not significantly different compared to their baseline measurements (n = 18, M = 49.6, SD = 16.0 vs. M = 51.0, SD = 12.1; t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (rs = -0.85, p = 0.74), pain (rs = 0.31, p = 0.23) or respiratory tract secretions (rs = -0.34, p = 0.19). CONCLUSIONS This is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. Our data demonstrates the feasibility of using an advance consent method to conduct research in dying people. This method can potentially improve the evidence base (and hence, quality of care) for the dying. Future BIA research can involve hydration assessment of cancers (according to type and stage) and associated variables (e.g., stage of illness, ethnicity and gender). Further work can use BIA to identify clinically relevant outcomes for hydration studies and establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer.
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Affiliation(s)
- Amara Callistus Nwosu
- Lancaster Medical School, Lancaster University, Lancaster, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
- Marie Curie Hospice Liverpool, Liverpool, UK.
- Palliative Care Unit, University of Liverpool, Liverpool, UK.
| | - Sarah Stanley
- Marie Curie Hospice Liverpool, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
| | - Catriona R Mayland
- Palliative Care Unit, University of Liverpool, Liverpool, UK
- University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Mason
- Palliative Care Unit, University of Liverpool, Liverpool, UK
| | | | - John E Ellershaw
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Palliative Care Unit, University of Liverpool, Liverpool, UK
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Branco MG, Mateus C, Capelas ML, Pimenta N, Santos T, Mäkitie A, Ganhão-Arranhado S, Trabulo C, Ravasco P. Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review. Nutrients 2023; 15:4792. [PMID: 38004186 PMCID: PMC10675768 DOI: 10.3390/nu15224792] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Bioelectrical Impedance Analysis (BIA) is a reliable, non-invasive, objective, and cost-effective body composition assessment method, with high reproducibility. This scoping review aims to evaluate the current scientific and clinical evidence on BIA for body composition assessment in oncology patients, under active treatment. Literature search was conducted through MEDLINE, CINAHL, Scopus and Web of Science databases, following PRISMA-ScR Guidelines. Inclusion criteria comprised studies reporting the use of BIA for body composition evaluation in adults with cancer diagnosis. Studies including non-cancer pathology or only assessing nutritional status were excluded. This scoping review comprised a total of 36 studies: 25 were original studies including 18 prospective studies, six cross-sectional studies and one retrospective study and 11 were systematic reviews. Population size for the included original articles ranged from 18 to 1217 participants, comprising a total of 3015 patients with cancer with a mean baseline Body Mass Index (BMI) ranging from 20.3 to 30.0 kg/m2 and mean age ranging between 47 and 70 years. Review articles included a total of 273 studies, with a total of 78,350 participants. The current review considered studies reporting patients with head and neck cancer (HNC) (n = 8), breast cancer (BC) (n = 4), esophageal cancer (EC) (n = 2), liver cancer (n = 2), pancreatic cancer (PC) (n = 3), gastric cancer (GC) (n = 3), colorectal cancer (CRC) (n = 8), lung cancer (LC) (n = 1), skin cancer (SK) (n = 1) and multiple cancer types (n = 6). BIA is a suitable and valid method for the assessment of body composition in oncology. BIA-derived measures have shown good potential and relevant clinical value in preoperative risk evaluation, in the reduction of postoperative complications and hospital stay and as an important prognostic indicator in persons with cancer. Future research on the diagnostic value and clinical applications of BIA and BIA-derived phase angle (PhA) should be conducted in order to predict its impact on patient survival and other clinical outcomes.
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Affiliation(s)
- Mariana Garcia Branco
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Nutrition and Dietetics, Hospital de Cascais Dr. José de Almeida, 2755-009 Alcabideche, Portugal
| | - Carlota Mateus
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
| | - Manuel Luís Capelas
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
| | - Nuno Pimenta
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Polytechnic Institute of Santarém, Sport Sciences School of Rio Maior, 2040-413 Rio Maior, Portugal
- Interdisciplinary Centre for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Lisbon, Portugal
| | - Teresa Santos
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Universidade Europeia, 1500-210 Lisbon, Portugal
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland;
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska University Hospital, Karolinska Institute, 17176 Stockholm, Sweden
| | - Susana Ganhão-Arranhado
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Atlântica, Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- CINTESIS, Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Carolina Trabulo
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Medical Oncology, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal
| | - Paula Ravasco
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Católica Medical School, Universidade Católica Portuguesa, 2635-631 Rio de Mouro, Portugal
- Centre for Interdisciplinary Research in Health Egas Moniz (CiiEM), 2829-511 Almada, Portugal
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Lee S, Kim J, Kim JS. Current Status of Korean Alcohol Drinking in Accordance with the Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing. Korean J Fam Med 2023; 44:129-142. [PMID: 37225438 DOI: 10.4082/kjfm.23.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
Since each person has a different ability to break down alcohol, it is inappropriate to apply a uniform standard to everyone when evaluating drinking status. In Korea, there has been a guideline for moderate drinking based not only on sex and age but Koreans' alcohol metabolism capabilities that can be predicted by presence of facial flushing response. So far, there have been no studies that have investigated drinking habits of Koreans in accordance with the guideline. This study tried to identify the current drinking status of Koreans according to the guideline. As a result, it was confirmed that about 1/3 of the total population was accompanied by facial flushing when drinking alcohol, and it was found that different drinking habits were shown even in the same age and gender groups according to the presence of facial flushing. It is difficult to accurately evaluate drinking habits because facial flushing has not yet been investigated in some large data or various medical examinations. In the future, it is necessary to ensure that the presence of facial flushing can be confirmed at the medical treatment or examination site so that accurate drinking habit evaluation and prevention and resolution of drinking problems can be achieved.
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Affiliation(s)
- Sami Lee
- Department of Family Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jihan Kim
- Department of Family Medicine, Sejong Trinium Woman's Hospital, Sejong, Korea
- Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Sung Kim
- Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Tsukahara A, Yamaguchi T, Tanaka Y, Ueno A. FPGA-Based Processor for Continual Capacitive-Coupling Impedance Spectroscopy and Circuit Parameter Estimation. SENSORS (BASEL, SWITZERLAND) 2022; 22:4406. [PMID: 35746187 PMCID: PMC9228433 DOI: 10.3390/s22124406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
In principle, the recently proposed capacitive-coupling impedance spectroscopy (CIS) has the capability to acquire frequency spectra of complex electrical impedance sequentially on a millisecond timescale. Even when the measured object with time-varying unknown resistance Rx is capacitively coupled with the measurement electrodes with time-varying unknown capacitance Cx, CIS can be measured. As a proof of concept, this study aimed to develop a prototype that implemented the novel algorithm of CIS and circuit parameter estimation to verify whether the frequency spectra and circuit parameters could be obtained in milliseconds and whether time-varying impedance could be measured. This study proposes a dedicated processor that was implemented as field-programmable gate arrays to perform CIS, estimate Rx and Cx, and their digital-to-analog conversions at a certain time, and to repeat them continually. The proposed processor executed the entire sequence in the order of milliseconds. Combined with a front-end nonsinusoidal oscillator and interfacing circuits, the processor estimated the fixed Rx and fixed Cx with reasonable accuracy. Additionally, the combined system with the processor succeeded in detecting a quick optical response in the resistance of the cadmium sulfide (CdS) photocell connected in series with a capacitor, and in reading out their resistance and capacitance independently as voltages in real-time.
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Affiliation(s)
- Akihiko Tsukahara
- School of Science and Engineering, Division of Electronic Engineering, Tokyo Denki, Saitama 350-0394, Japan
| | - Tomiharu Yamaguchi
- Department of Electrical and Electronic Engineering, Tokyo Denki University, Tokyo 120-8551, Japan; (T.Y.); (Y.T.); (A.U.)
| | - Yuho Tanaka
- Department of Electrical and Electronic Engineering, Tokyo Denki University, Tokyo 120-8551, Japan; (T.Y.); (Y.T.); (A.U.)
| | - Akinori Ueno
- Department of Electrical and Electronic Engineering, Tokyo Denki University, Tokyo 120-8551, Japan; (T.Y.); (Y.T.); (A.U.)
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5
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Yamaguchi T, Ogawa E, Ueno A. Short-Time Impedance Spectroscopy Using a Mode-Switching Nonsinusoidal Oscillator: Applicability to Biological Tissues and Continuous Measurement. SENSORS (BASEL, SWITZERLAND) 2021; 21:6951. [PMID: 34770258 PMCID: PMC8587290 DOI: 10.3390/s21216951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023]
Abstract
Herein, we propose an impedance spectroscopy method using a mode-switching nonsinusoidal oscillator and apply this method for measuring the impedance of biological tissues and continuous impedance measurement. To obtain impedance spectra over a wide frequency range, we fabricated a novel nonsinusoidal oscillator incorporating binary counters and analog switches. This oscillator could periodically switch oscillation frequency through the mode switching of the feedback resistor. From the oscillation waveform at each oscillation frequency of this circuit (oscillator), we determined the impedance spectrum of a measured object using the discrete-time Fourier transform. Subsequently, we obtained the broad impedance spectrum of the measured object by merging odd-order harmonic spectral components up to the 19th order for each oscillation frequency. From the measured spectrum, the resistive and capacitive components of the circuit simulating bioimpedance were estimated with high accuracy. Moreover, the proposed method was used to measure the impedance of porcine myocardium; changes in the impedance spectrum of the myocardial tissue due to coagulation could be measured. Furthermore, rapid variations in the resistance value of a CdS photocell could be continuously measured using the proposed method.
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Affiliation(s)
- Tomiharu Yamaguchi
- Department of Electrical and Electronic Engineering, Tokyo Denki University, Tokyo 120-8551, Japan;
| | - Emiyu Ogawa
- School of Allied Health Science, Kitasato University, Kanagawa 252-0373, Japan;
| | - Akinori Ueno
- Department of Electrical and Electronic Engineering, Tokyo Denki University, Tokyo 120-8551, Japan;
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Almeida AR, Santana RF, Brandão MAG. Compromised end-of-life syndrome: Concept development from the condition of adults and older adults in palliative care. Int J Nurs Knowl 2021; 33:128-135. [PMID: 34546666 DOI: 10.1111/2047-3095.12344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to develop the nursing diagnosis concept "compromised end-of-life syndrome" in palliative care. METHODS The authors used the integrative strategy by Meleis to develop the concept in this study and identifying clinical indicators from a literature review. For data organization, we applied the Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA). FINDINGS Some clusters of unpleasant signs and symptoms in palliative care patients at the end of life, such as pain, dyspnea, depression, constipation, and anxiety, were identified. Through conceptualization, the authors propose a new nursing diagnosis, "compromised end-of-life syndrome." The manuscript includes a model case of a patient with nursing diagnosis syndrome as a clinical example. CONCLUSIONS Simultaneous patterns of signs and symptoms present in the literature reinforce the utility of the proposition of end-of-life syndrome as a nursing diagnostic construct. IMPLICATIONS FOR NURSING PRACTICE The concept development related to patients' unpleasant signs and symptoms critically ill at palliative care supports the proposition of a new nursing diagnosis relevant to selecting adequate nursing interventions and nursing outcomes. Some clusters of unpleasant signs and symptoms in palliative care patients at the end of life, such as pain, dyspnea, depression, constipation, and anxiety were identified. Conceptualization was used to propose a new nursing diagnosis, "compromised end-of-life syndrome." A model case of a patient with nursing diagnosis syndrome is described as a clinical example. CONCLUSION Simultaneous patterns of signs and symptoms present in the literature reinforce the utility of the proposition of end-of-life syndrome as nursing diagnostic construct. IMPLICATIONS FOR NURSING PRACTICE The concept development related to patients' unpleasant signs and symptoms critically ill at palliative care supports the proposition of a new nursing diagnosis relevant to selecting adequate nursing interventions and nursing outcomes.
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Affiliation(s)
- Antônia Rios Almeida
- Nurse, Department of Neurosurgery and Thoracic Surgery, José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
| | - Rosimere Ferreira Santana
- Nurse, Teacher, Aurora de Afonso Costa Nursing School, Fluminense Federal University, Rio de Janeiro, Brazil
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Machado VMQ, Justa RMDE, Lopes da Costa S, Barbosa MC, Damasceno NRT, Verde SMML. Bioelectrical impedance vector applied to body composition evaluation of women survivors of breast cancer: A longitudinal study. Clin Nutr ESPEN 2021; 44:247-253. [PMID: 34330474 DOI: 10.1016/j.clnesp.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Thus, the aim of this study was to assess the changes in the body composition of the women survivors of breast cancer and its association with clinical staging, using the bioelectrical impedance vector analysis (BIVA), over five years of follow-up. METHODS At baseline time 114 patients (T0) were selected and after 5 years (T1) of follow-up (n = 35) data of weight, body mass index, waist circumference, phase angle, resistance/height, reactance/height, %fat free mass and %fat mass were monitored. Bioelectrical impedance vector analysis (BIVA) and the vector displacement assessment took place according to the initial and advanced clinical staging (CS 1 and 2, respectively) and time of follow-up and have been showed using mean graph and RXc score graph. RESULTS Patients on CS 1 showed a reduction in reactance/height, phase angle, %fat free mass and an increase in %fat mass. The same group presented during the follow-up significant vector displacement by mean graph and a change to the 95% ellipse by the RXc score graph. CONCLUSIONS Women with breast cancer in the initial CS showed a more significant displacement of bioelectric vectors, indicating worsening in body composition.
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Affiliation(s)
| | | | - Sâmia Lopes da Costa
- Postgraduate Program in Nutrition and Health, State University of Ceara, Fortaleza, Ceara, Brazil.
| | - Manuela Cunha Barbosa
- Postgraduate Program in Nutrition and Health, State University of Ceara, Fortaleza, Ceara, Brazil.
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Yamaguchi T, Ueno A. Capacitive-Coupling Impedance Spectroscopy Using a Non-Sinusoidal Oscillator and Discrete-Time Fourier Transform: An Introductory Study. SENSORS 2020; 20:s20216392. [PMID: 33182456 PMCID: PMC7665133 DOI: 10.3390/s20216392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 01/10/2023]
Abstract
In this study, we propose a new short-time impedance spectroscopy method with the following three features: (1) A frequency spectrum of complex impedance for the measured object can be obtained even when the measuring electrodes are capacitively coupled with the object and the precise capacitance of the coupling is unknown; (2) the spectrum can be obtained from only one cycle of the non-sinusoidal oscillation waveform without sweeping the oscillation frequency; and (3) a front-end measuring circuit can be built, simply and cheaply, without the need for a digital-to-analog (D-A) converter to synthesize elaborate waveforms comprising multiple frequencies. We built the measurement circuit using the proposed method and then measured the complex impedance spectra of 18 resistive elements connected in series with one of three respective capacitive couplings. With this method, each element's resistance and each coupling's capacitance were estimated independently and compared with their nominal values. When the coupling capacitance was set to 10 nF or 1.0 nF, estimated errors for the resistive elements in the range of 2.0-10.0 kΩ were less than 5%.
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9
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The why and how of maintaining hydration during cancer therapy. Curr Opin Support Palliat Care 2020; 14:324-332. [PMID: 33009008 DOI: 10.1097/spc.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of the role hydration plays in the oncology population while providing a synopsis of recent scientifically relevant published practice advancements. RECENT FINDINGS Dehydration causes substantial symptom burden in cancer patients, secondary to both disease process and treatment complications. Maintaining fluid and electrolytes balance is the key to hydration therapy. When oral intake is diminished, artificial hydration can be delivered via enteral, intravenous and subcutaneous routes. Use of artificial hydration in end-of-life care for cancer patients remains a highly debated topic with unclear benefits and lack of established standards. A holistic approach is required in the decision-making process. SUMMARY Maintaining adequate hydration is important in patients receiving cancer therapy. Challenges exist, secondary to limited clinical guidelines of hydration in patients with advanced cancer. Artificial hydration may be indicated for selected patients at the end of life if used on an individualized basis as medical treatment.
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Beland P. Artificial hydration at the end of life: balancing benefits and risks in the absence of conclusive evidence. Nurs Stand 2020; 35:61-65. [PMID: 32875752 DOI: 10.7748/ns.2020.e11595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/09/2022]
Abstract
There is a lack of clear evidence regarding the benefits and harm of artificial hydration at the end of life. Trial findings are conflicting and inconclusive, offering little basis for recommendations. As a result, the advantages and disadvantages of artificial hydration remain largely anecdotal, and decisions about its use, withholding or withdrawal are often based on opinion rather than evidence. In certain circumstances, some patients who are dying might derive benefit from artificial hydration in terms of reducing specific symptoms, such as delirium. This article explores the central questions pertaining to artificial hydration at the end of life by undertaking a critical exploration of the relevant literature.
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Affiliation(s)
- Paul Beland
- St Nicholas Hospice, Bury St Edmunds, England
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11
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Lokker ME, van der Heide A, Oldenmenger WH, van der Rijt CCD, van Zuylen L. Hydration and symptoms in the last days of life. BMJ Support Palliat Care 2019; 11:335-343. [PMID: 31473651 PMCID: PMC8380917 DOI: 10.1136/bmjspcare-2018-001729] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES At the end of life oral fluid intake is often reduced. Consensus about the most appropriate management for terminally ill patients with limited oral fluid intake is lacking. The objective of this study is to investigate to what extent the amount of fluid intake, preceding and during the dying phase, is related to the occurrence of death rattle and terminal restlessness. METHODS A multicentre prospective observational study was performed. Data on the occurrence of death rattle and terminal restlessness, fluid intake and opioid use of patients expected to die within a few days or hours were collected. RESULTS 371 patients were included. Death rattle was reported at least once in 40% (n=149) of patients during the dying phase. Death rattle occurrence was not associated with the amount of fluid intake during the days before dying. Terminal restlessness was reported in 26% of patients (n=96). Terminal restlessness was not associated with a lower amount of fluid intake during the days before dying. Terminal restlessness during the last 24 hours of life was associated with a higher amount of fluid (ie, >250 mL/day) during 48-25 hours before death. CONCLUSIONS Caution with fluid intake to prevent development of death rattle does not seem to be necessary. Our study suggests that a higher amount of fluid intake during 48-25 hours before death may be associated with the occurrence of terminal restlessness during the last 24 hours of life. These results suggest that actively providing dying patients with artificial fluid may not be beneficial.
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Affiliation(s)
| | | | | | | | - Lia van Zuylen
- Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
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O'Donnell M, Lorton C, Brady B, O'Connor B, O'Meachair A, O'Leary N, Walsh D. Comment on "Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children". Nutr Clin Pract 2019; 34:639-640. [PMID: 31144354 DOI: 10.1002/ncp.10311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Cliona Lorton
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland
| | - Bernadette Brady
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Brenda O'Connor
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Norma O'Leary
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland.,St. James's Hospital, Dublin, Ireland
| | - Declan Walsh
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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13
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Vermeulen KM, Lopes MMGD, Grilo EC, Alves CX, Machado RJA, Lais LL, Brandão-Neto J, Vale SHL. Bioelectrical impedance vector analysis and phase angle in boys with Duchenne muscular dystrophy. Food Nutr Res 2019; 63:1615. [PMID: 31007651 PMCID: PMC6458958 DOI: 10.29219/fnr.v63.1615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of functional muscle mass followed by changes in body composition. Objective This study aimed to describe and evaluate bioimpedance parameters in boys with DMD. Design This cross-sectional, descriptive study investigated children and adolescents diagnosed with DMD. Age, weight, height, resistance, and reactance data were collected. Phase angle and bioelectrical impedance vector analysis were calculated based on resistance and reactance values. Results We analyzed 43 boys aged between 2.7 and 19.8 years. Low-phase angle values were observed during the investigation of bioimpedance parameters. Bioelectrical impedance vector analysis showed that approximately 87% of the subjects presented vectors outside the tolerance ellipses, and only one patient presented vectors located within the 50% tolerance ellipse, indicating normally hydrated and a good body cell mass. Compared with the reference population, boys with DMD had lower levels of body cell mass. Conclusion Based on the evidence, compared with the reference population, patients with DMD had lower levels of body cell mass. This evidence points to bioimpedance parameters as useful tools for the nutritional evaluation and clinical management of patients with DMD.
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Affiliation(s)
- Karina M Vermeulen
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Márcia M G D Lopes
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Evellyn C Grilo
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Camila X Alves
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Richele J A Machado
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lucia L Lais
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - José Brandão-Neto
- Departament of Internal Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Sancha H L Vale
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
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Bioelectrical impedance vector analysis (BIVA) as a method to compare body composition differences according to cancer stage and type. Clin Nutr ESPEN 2019; 30:59-66. [DOI: 10.1016/j.clnesp.2019.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
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15
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Caccialanza R, Cereda E, Caraccia M, Klersy C, Nardi M, Cappello S, Borioli V, Turri A, Imarisio I, Lasagna A, Saddi J, Arcaini L, Benazzo M, Stragliotto S, Zagonel V, Pedrazzoli P. Early 7-day supplemental parenteral nutrition improves body composition and muscle strength in hypophagic cancer patients at nutritional risk. Support Care Cancer 2018; 27:2497-2506. [DOI: 10.1007/s00520-018-4527-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/23/2018] [Indexed: 12/22/2022]
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16
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Hui D, Moore J, Park M, Liu D, Bruera E. Phase Angle and the Diagnosis of Impending Death in Patients with Advanced Cancer: Preliminary Findings. Oncologist 2018; 24:e365-e373. [PMID: 30352942 PMCID: PMC6656508 DOI: 10.1634/theoncologist.2018-0288] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/01/2018] [Indexed: 01/29/2023] Open
Abstract
This article reports on the association between phase angle, which is measured by bioelectric impedance analysis and reflects cellular integrity and hydration level, and survival in patients with advanced cancer. Background. Phase angle is a prognostic factor in patients with months of survival, but its accuracy has not been examined in patients with weeks/days of survival. We determined the association between phase angle and survival in patients with advanced cancer admitted to an acute palliative care unit (APCU). Subjects, Materials, and Methods. We prospectively assessed phase angle in consecutive patients with advanced cancer admitted to our APCU. We conducted univariate and multivariate survival analyses adjusting for established prognostic factors. Post hoc subgroup analyses examined patients with and without edema. Results. Among 204 patients, the median overall survival was 10 days (95% confidence interval [CI] 8–11 days). Seventy‐four (36%) did not have edema. The median phase angle was 3.7° for the entire cohort, 3.9° for the nonedematous subgroup and 3.6° for the edematous subgroup. In univariate analysis, a low phase angle was associated with decreased survival for the entire cohort (≤3° vs. >3°, median survival 7 vs. 10 days, p = .045) and the nonedematous subgroup (5 vs. 18 days, p < .001) but not the edematous subgroup (9 vs. 9 days, p = .84). In multivariate analysis, phase angle did not reach significance for the entire cohort but remained significant in the nonedematous subgroup (hazard ratio 2.46, 95% CI 1.14–5.31, p < .001). Specifically, phase angle ≤3° had an accuracy of 86% (95% CI 77%–93%) for 3‐day survival in patients without edema. Conclusion. Phase angle had limited prognostic utility in unselected APCU patients but was significant in the nonedematous subgroup. Further studies are required to confirm these preliminary findings. Implications for Practice. In this prospective study involving 204 patients with advanced cancer, phase angle as measured by bioelectric impedance analysis was a significant predictor of mortality independent of known prognostic factors in patients without edema but not patients with edema. Among patients without edema, a phase angle ≤3° had an accuracy of 86% for 3‐day survival, which may inform the diagnosis of impending death and potentially end‐of‐life decision making.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Moore
- Section of Integrated Ethics in Cancer Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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17
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Yokoyama T, Terawaki K, Minami K, Miyano K, Nonaka M, Uzu M, Kashiwase Y, Yanagihara K, Ueta Y, Uezono Y. Modulation of synaptic inputs in magnocellular neurones in a rat model of cancer cachexia. J Neuroendocrinol 2018; 30:e12630. [PMID: 29944778 DOI: 10.1111/jne.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
In cancer cachexia, abnormal metabolism and neuroendocrine dysfunction cause anorexia, tissue damage and atrophy, which can in turn alter body fluid balance. Arginine vasopressin, which regulates fluid homeostasis, is secreted by magnocellular neurosecretory cells (MNCs) of the hypothalamic supraoptic nucleus. Arginine vasopressin secretion by MNCs is regulated by both excitatory and inhibitory synaptic activity, alterations in plasma osmolarity and various peptides, including angiotensin II. In the present study, we used whole-cell patch-clamp recordings of brain slices to determine whether hyperosmotic stimulation and/or angiotensin II potentiate excitatory synaptic input in a rat model of cancer cachexia, similar to their effects in normal (control) rats. Hyperosmotic (15 and 60 mmol L-1 mannitol) stimulation and angiotensin II (0.1 μmol L-1 ) increased the frequency, but not the amplitude, of miniature excitatory postsynaptic currents in normal rats; in model rats, both effects were significantly attenuated. These results suggest that cancer cachexia alters supraoptic MNC sensitivity to osmotic and angiotensin II stimulation.
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Affiliation(s)
- Toru Yokoyama
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
- Department of Physiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kiyoshi Terawaki
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
- Tsumura Research Laboratories, Tsumura & Co., Ibaraki, Japan
| | - Kouichiro Minami
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
- Department of Physiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kanako Miyano
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
| | - Miki Nonaka
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
| | - Miaki Uzu
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
| | - Yohei Kashiwase
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
- Laboratory of Molecular Pathology and Metabolic Disease, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Japan
| | - Kazuyoshi Yanagihara
- Division of Biomarker Discovery, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Yoichi Ueta
- Department of Physiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhito Uezono
- Cancer Pathophysiology Division, National Cancer Center Research Institute, Tokyo, Japan
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Davies AN, Waghorn M, Webber K, Johnsen S, Mendis J, Boyle J. A cluster randomised feasibility trial of clinically assisted hydration in cancer patients in the last days of life. Palliat Med 2018; 32:733-743. [PMID: 29343167 DOI: 10.1177/0269216317741572] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The provision of clinically assisted hydration at the end-of-life is one of the most contentious issues in medicine. AIM The aim of this feasibility study was to answer the question 'can a definitive (adequately powered) study be done?' DESIGN The study was a cluster randomised trial, with sites randomised on a one-to-one basis to intervention 'A' (regular mouth care and usual other care) or intervention 'B' (clinically assisted hydration, mouth care and usual other care). Participants were assessed every 4 h, and data collected on clinical problems, therapeutic interventions and overall survival. SETTING/PARTICIPANTS The study was conducted at 12 sites/'clusters' with specialist palliative care teams (4 cancer centres and 8 hospices), and participants were cancer patients in the last week of life who were unable to maintain sufficient oral fluid intake. RESULTS The study achieved its pre-determined criteria for success. Two hundred patients were recruited to the study, and 199 participants completed the study, over a 1-year period. A total of 38.5% participants discontinued clinically assisted hydration due to adverse effects: none of these adverse events were rated as 'severe' or worse in intensity. The primary reasons for discontinuation were site problems ( n = 2), localised oedema ( n = 13), generalised oedema ( n = 5), respiratory secretions ( n = 6) and nausea and vomiting ( n = 1). CONCLUSION The results of this feasibility study suggest that a definitive study can be done, but that minor changes are needed to the protocol to standardise the administration of clinically assisted hydration (which may reduce the incidence of certain adverse effects).
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Affiliation(s)
- Andrew N Davies
- 1 Royal Surrey County Hospital, Guildford, UK.,2 University of Surrey, Guildford, UK
| | | | - Katherine Webber
- 1 Royal Surrey County Hospital, Guildford, UK.,2 University of Surrey, Guildford, UK
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