Brief SC Infusions for Hydration Appear Well Tolerated in Advanced Cancer Patients

EDMONTON, Canada--Twice daily 1-hour bolus infusions for subcutaneoushydration (hypodermoclysis) of patients with advanced cancer appearto be effective and well tolerated, say Eduardo Bruera, MD, andhis colleagues at the University of Alberta. In addition, thestudy found that a lower dose of hyaluronidase (Wydase), an enzymeused to facilitate the absorption of water, is as effective asa higher dose.

Together, these findings could result in substantial cost savings,by reducing the volume of hyaluronidase used and by allowing easieroutpatient management. Subcutaneous infusion could also allowhydration in some patients for whom the IV route of continuoushydration might not be desirable.

The 25 evaluable patients all had advanced cancer and normal cognitivestatus, and were receiving hypodermoclysis as a continuous subcutaneousinfusion. Patients were randomized to receive, during day 1, alocal injection of 150 or 300 units of hyaluronidase immediatelybefore two 1-hour infusions of a solution of two thirds dextrose5% and one third normal saline. During day 2, a crossover tookplace, and patients received the alternative hyaluronidase dosebefore each of the two 1-hour infusions.

The study found no significant differences in pain and swelling(patient assessments) or edema and rash (investigator assessments)between the two hyaluronidase concentrations (J Pain Symptom Manage10:505-509, 1995).

The data also showed no significant differences in patient orinvestigator choice between previous experience with overnighthypodermoclysis and brief infusions. However, the study patientswere hospitalized, and the advantages of the brief infusions mightbe better perceived by patients who remain active at home, Dr.Bruera said. He also pointed out that the brief infusions mightbe preferred when families, rather than nurses, administer thetherapy to patients.