EDMONTON, Canada--Twice daily 1-hour bolus infusions for subcutaneous
hydration (hypodermoclysis) of patients with advanced cancer appear
to be effective and well tolerated, say Eduardo Bruera, MD, and
his colleagues at the University of Alberta. In addition, the
study found that a lower dose of hyaluronidase (Wydase), an enzyme
used to facilitate the absorption of water, is as effective as
a higher dose.
Together, these findings could result in substantial cost savings,
by reducing the volume of hyaluronidase used and by allowing easier
outpatient management. Subcutaneous infusion could also allow
hydration in some patients for whom the IV route of continuous
hydration might not be desirable.
The 25 evaluable patients all had advanced cancer and normal cognitive
status, and were receiving hypodermoclysis as a continuous subcutaneous
infusion. Patients were randomized to receive, during day 1, a
local injection of 150 or 300 units of hyaluronidase immediately
before two 1-hour infusions of a solution of two thirds dextrose
5% and one third normal saline. During day 2, a crossover took
place, and patients received the alternative hyaluronidase dose
before 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 Manage
The data also showed no significant differences in patient or
investigator choice between previous experience with overnight
hypodermoclysis and brief infusions. However, the study patients
were hospitalized, and the advantages of the brief infusions might
be better perceived by patients who remain active at home, Dr.
Bruera said. He also pointed out that the brief infusions might
be preferred when families, rather than nurses, administer the
therapy to patients.