Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study

Agar, MR; Chang, S; Amgarth-Duff, I; Garcia, MV; Hunt, J; Phillips, JL; Sinnarajah, A; Fainsinger, R

Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study

Agar, MR Chang, S

Amgarth-Duff, I Garcia, MV Hunt, J Phillips, JL Sinnarajah, A Fainsinger, R

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: Palliative Medicine, 2022, 36, (5), pp. 830-840
Issue Date:: 2022-05

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Field	Value	Language
dc.contributor.author	Agar, MR
dc.contributor.author	Chang, S https://orcid.org/0000-0003-0723-3192
dc.contributor.author	Amgarth-Duff, I
dc.contributor.author	Garcia, MV
dc.contributor.author	Hunt, J
dc.contributor.author	Phillips, JL
dc.contributor.author	Sinnarajah, A
dc.contributor.author	Fainsinger, R
dc.date.accessioned	2022-05-10T01:59:25Z
dc.date.available	2022-05-10T01:59:25Z
dc.date.issued	2022-05
dc.identifier.citation	Palliative Medicine, 2022, 36, (5), pp. 830-840
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/157196
dc.description.abstract	<jats:sec><jats:title>Background:</jats:title><jats:p> Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration (‘hypodermoclysis’) has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. </jats:p></jats:sec><jats:sec><jats:title>Aim:</jats:title><jats:p> To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. </jats:p></jats:sec><jats:sec><jats:title>Design:</jats:title><jats:p> Multisite, multinational consecutive cohort study. </jats:p></jats:sec><jats:sec><jats:title>Setting/participants:</jats:title><jats:p> Patients receiving hypodermoclysis in an inpatient palliative care setting. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis. </jats:p></jats:sec>
dc.language	en
dc.publisher	SAGE Publications
dc.relation.ispartof	Palliative Medicine
dc.relation.isbasedon	10.1177/02692163221082245
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.title	Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study
dc.type	Journal Article
utslib.citation.volume	36
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access	*
dc.date.updated	2022-05-10T01:59:23Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	5

Abstract:

Background: Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration (‘hypodermoclysis’) has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. Aim: To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. Design: Multisite, multinational consecutive cohort study. Setting/participants: Patients receiving hypodermoclysis in an inpatient palliative care setting. Results: Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). Conclusions: Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis.

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http://hdl.handle.net/10453/157196