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(Drug information on 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(Drug information on 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 10:505-509, 1995).
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.
