Background: Hypodermoclysis (HDC) refers to a subcutaneous infusion of fluids which is then absorbed into circulation via diffusion and perfusion. Compared with different intravenous accesses, HDC has a lower incidence of side-effects, such as local pain, infections, bleeding or allergies. In recent years, HDC has been increasingly used for palliation of advanced solid cancers, especially when oral intake is impaired. On the other hand, there is scarce data regarding the safety and efficacy of HDC in patients with hematological cancers (HC) who are intrinsically more prone to infections and/or bleeding. Since 2019, we have been using HDC for palliation of HC at our institution. Here, we report our experience.
Aims: To analyze the safety and efficacy of HDC for palliation of patients with HC.
Methods: This was a retrospective single-center study conducted at the General Hospital of Sibenik-Knin County, Croatia. Clinical and laboratory data regarding patients with HC under palliative care who have been hospitalized and treated with HDC (BD SAF-T-Intima®, Braun) was collected through the medical chart review. Age- and sex-matched patients with advanced solid cancers and those with impaired oral intake and/or poor venous access treated with HDC served as controls. The chi-square and the Mann-Whitney U tests were used. P-value <0.050 was considered statistically significant. MedCalc Statistical Software® (Ostend, Belgium, ver. 20.014) was used for all statistical analyses.
Results: Thirty-two (54.2%) patients with HC under palliative care (non-Hodgkin lymphoma=10, acute myeloid leukemia=9, myelodisplastic syndrome=7, multiple myeloma/plasma cell leukemia=6) and 27 (45.8%) controls (metastatic lung cancer=6, metastatic breast cancer=1, dementia=3, mental retardation=1, other=16) were retrospectively included in the period between January 2019 and January 2022.
Infused drugs included isotonic fluids (5% glucose, 0.9% saline, Ringer’s solution) in 100%, tramadole in 81.25%, parenteral potassium in 78.1%, furosemide in 78.1%, dexamethasone in 18.75%, meropenem in 12.5%, methylprednisolone in 6.25%, diazepam in 6.25%, haloperidol in 6.25%, gentamicin in 6.25%, morphine in 6.25% and ketoprofen in 3.1% of patients with HC.
Even though the duration of HDC in patients with HC was longer (median 6 vs. 3 days; p<0.001), and the fact that HC patients more often needed erythrocyte/platelet transfusions (71.9% vs. 0%; p<0.001), had lower total leukocyte (median 3.5x10 9 /L vs. 9.6 x10 9 /L; p=0.008), absolute neutrophil (1.86 x10 9 /L vs. 7.1 x10 9 /L; p=0.004) and platelet counts (40 x10 9 /L vs. 271 x10 9 /L; p<0.001), as well as a higher proportions of patients with granulocytopenia (<1500/mL, 46.9% vs. 3.7%; p<0.001) and severe thrombocytopenia (<50 x10 9 /L, 53% vs. 0%; p<0.001), HDC-related infections (0% vs. 0%), bleedings (0% vs. 0%), allergies (0% vs. 0%) and pain (9.4% vs. 7.4%; p=0.787) were entirely absent or minimal in both patient groups. Finally, a higher proportion of patients with HC was eventually discharged from the hospital (78.1% vs. 55.7%; p=0.066).
Summary/Conclusion: Our data shows that HDC is safe and effective for palliation of hospitalized patients with HC. Limitations of this study are its retrospective single-center design and the lack of evaluation of other patient-reported outcomes. Nevertheless, this data confirms the excellent safety of HDC for palliation of patients with both solid and HC.