[Should nutritional support and fluid therapy be used in terminal care? Guidelines for structured decision-making]

A panel of experts within the European Association for Palliative Care (EAPC) have drawn up guidelines as an aid to decision making concerning nutritional support and fluid therapy in palliative cancer care. However, the issue is characterised by a lack of scientifically based indications. The article consists in discussion of the question of fluid therapy in terminal cases, in the light of the EAPC guidelines. A meticulous assessment should be made of the patient in terms of oncological and clinical status, symptomatology, prognosis, fluid and nutritional status, nutrient and fluid intake, psychological attitudes, gastro-intestinal function, and the availability of technical expertise in enteral or parenteral nutrition and fluid therapy. Case reports are used to illustrate the importance of taking these factors into consideration, and of careful weighing of the pros and cons.