Non-invasive technology to assess hydration status in advanced cancer - an observational study using bioelectrical impedance analysis

Q: What was the main aim of using bioelectrical impedance analysis in advanced cancer?

To determine the association between hydration status and symptoms, clinical signs, quality of life, and survival in advanced cancer, including patients in the last week of life.

Q: How was hydration status estimated in the study?

Total body water was estimated using the BIA impedance index, expressed as (Height − H (m)2 / Resistance − R (Ohms)), and analyses focused on H2/R.

Q: Which factors were associated with less hydration and more hydration?

Less hydration (lower H2/R) was associated with female sex, increased appetite, higher dehydration assessment scale score (e.g., dry mouth, dry axilla, sunken eyes), and increased breathlessness. More hydration (higher H2/R) was associated with oedema.

Sep 21, 2026

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Oral fluid intake decreases during the dying phase of advanced cancer, yet evidence remains insufficient for assessing and managing hydration. This observational study used bioelectrical impedance analysis (BIA), estimating total body water via the H2/R impedance index, to examine associations between hydration status, symptoms, clinical signs, quality of life, and survival. Backward regression identified clinical predictors, and repeat BIA assessed hydration change in those in the last week of life.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

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Aim

Materials and methods

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Nwosu etal. BMC Palliative Care (2024) 23:209 BMC Palliative Care [https://doi.org/10.1186/s12904-024-01542-z](https://doi.org/10.1186/s12904-024-01542-z) RESEARCH Open Access 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 Amara Callistus Nwosu 1,2,3,4*, Sarah Stanley3,5, Catriona R Mayland4,6,7, Stephen Mason4, Alexandra McDougall8 and John E Ellershaw2,4 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](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; *Correspondence: Amara Callistus Nwosu[a. nwosu@lancaster.ac.uk](a. nwosu@lancaster.ac.uk) Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://](http://)[ ](http://)[creativecommons.org/l](creativecommons.org/l)icenses/by-nc-nd/4.0/. Nwosu et al. BMC Palliative Care (2024) 23:209 Page 2 of 18 t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (rs = -0.85

FAQs

What was the main aim of using bioelectrical impedance analysis in advanced cancer?

To determine the association between hydration status and symptoms, clinical signs, quality of life, and survival in advanced cancer, including patients in the last week of life.

How was hydration status estimated in the study?

Total body water was estimated using the BIA impedance index, expressed as (Height − H (m)2 / Resistance − R (Ohms)), and analyses focused on H2/R.

Which factors were associated with less hydration and more hydration?

Less hydration (lower H2/R) was associated with female sex, increased appetite, higher dehydration assessment scale score (e.g., dry mouth, dry axilla, sunken eyes), and increased breathlessness. More hydration (higher H2/R) was associated with oedema.

Sep 21, 2026

Upload by Asher