Nutrition and Hydration for the Terminally III-Reply

In Reply. —We appreciate the comments of Dr Fainsinger. The articles we cited that failed to show a benefit of nutritional support in cancer patients used total parenteral nutrition that included adequate hydration. In the study by Clamon et al,1the use of intravenous hyperalimentation in cancer patients at a relatively early stage in their illness failed to show any benefit in survival or amelioration of toxicity. Fainsinger is correct that hydration was not addressed separately. We did not advocate "giving no fluids at all" in our study, but rather letting the patients determine the amount of fluids that they would ingest. The patients that were excluded from our study did not have the capacity to make their needs known consistently or for a long enough portion of their stay (>25% of admission days) to be included in our study. Most of these were obtunded (seven patients) and died