Hypodermoclysis as a Strategy for Patients With End-of-Life Cancer in Home Care Settings

Abstract

Background:

The increase in the elderly population associated with a higher incidence of cancer strongly endorses palliative care (PC). Hypodermoclysis (HDC) is a feasible technique for drugs and fluids delivery at the home care setting.

Objectives:

To assess the use and benefits of HDC in patients with end-of-life cancer assisted by a single home-based palliative care program (HPCP) in Belo Horizonte, Brazil.

Methods:

This was a retrospective study that analyzed medical charts from patients with end-of-life cancer who were assisted by an HPCP in a 1-year period of time.

Results:

A total of 333 patients, 81.7% with advanced cancer, were included. The most frequent symptoms were fatigue (44.4%) and pain (43.2%). Hypodermoclysis was used in 77.5% of the patients for the administration of fluids or medicines. Continuous palliative sedation was applied to 70.5% of patients. The place of death was home for 90.2% of the patients.

Conclusion:

Receiving home care assistance with palliative intention may decrease the need for dying patients with cancer to visit emergency units, as their symptoms were well controlled. Hypodermoclysis was a safe and effective alternative for hydration and drug delivery when provided and supervised by an experienced team. The place of death is a reliable indicator of the quality of death, and, in this study, the HPCP allowed patients to die at home with their families. It is essential for PC professionals to understand the impact of HDC use at home care setting for patients with end-of-life cancer allowing the increase of quality of death indicators.

Keywords

hypodermoclysis palliative care neoplasms pain terminal care nursings

Get full access to this article

View all access options for this article.

References

Bray

Ferlay

Soerjomataram

, et al. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

Ferrell

Temel

Temin

, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2017;35(1):96–112.

Hui

Bruera

. Models of integration of oncology and palliative care. Ann Palliat Med. 2015;4:89–98.

Saga

Enokido

Iwata

, et al. Transitions in palliative care: conceptual diversification and the integration of palliative care into standard oncology care. Chin Clin Oncol. 2018;7(3):32.

Maetens

Beernaert

Deliens

, et al. Policy measures to support palliative care at home: a cross-country case comparison in three European countries. J Pain Symptom Manage. 2017;54(4):523–529.e5.

Smith

. Hypodermoclysis with older adults. Nursing. 2014;44(12):66.

Humphrey

. Hypodermoclysis: an alternative to I.V. infusion therapy. Nursing. 2011;41(11):16–17.

Dalal

Bruera

. Dehydration in cancer patients: to treat or not to treat. J Support Oncol. 2004;2(6):467–479, 483. Review.

Fainsinger

. Dehydration and rehydration. In: Bruera

Higginson

Ripamonti

von Gunten

, eds. Textbook of Palliative Medicine. London, England: Hodder Arnold; 2006:727–735.

10.

Slesak

Schnurle

Kinzel

, et al. Comparison of subcutaneous and intravenous rehydration in geriatric patients: a randomized trial. J Am Geriatr Soc. 2003;51:155–160.

11.

Farrand

Campbell

. Safe, simple subcutaneous fluid administration. Br J Hosp Med. 1996;55:690–692.

12.

Arinzon

Feldman

Fidelman

, et al. HDC (subcutaneous infusion) effective mode of treatment of dehydration in long-term care patients. Arch Gerontol Geriatr. 2004;38(2):167–173.

13.

Bruno

. HDC: a literature review to assist in clinical practice. Einstein (Sao Paulo). 2015;13(1):122–128.

14.

Sasson

Shvartzman

. HDC: an alternative infusion technique. Am Fam Physician. 2001;64(9):1575–1578.

15.

Cherny

ESMO Guidelines Working Group . ESMO Clinical Practice guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014;25(suppl 3):iii143–152.

16.

Dunphy

Finlay

Rathbone

, et al.

Rehydration in palliative and terminal care: if not—why not?

Palliat Med. 1995;9(3):221–228. Review.

17.

Fainsinger

Bruera

. HDC (HDC) for symptom control vs. the Edmonton injector (EI). J Palliat Care. 1991;7(4):5–8.

18.

Finlay

Higginson

Goodwin

, et al. Palliative care in hospital, hospice, at home: results from a systematic review. Ann Oncol. 2002;13(suppl 4):257–264.

19.

Higginson

Finlay

Goodwin

, et al.

Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?

J Pain Symptom Manage. 2003;25(2):150–168.

20.

Armento

Gysels

Higginson

, et al. Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers. BMJ Support Palliat Care. 2017;7(4):0.

21.

Adsersen

Thygesen

Jensen

, et al. Is admittance to specialized palliative care among cancer patients related to sex, age, and cancer diagnosis? A nation-wide study from the Danish Palliative Care Database (DPD). BMC Palliat Care. 2017;16(1):21.

22.

Sharma

Prigerson

Penedo

, et al. Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death. Cancer. 2015;121(16):2814–2820.

23.

Instituto Nacional de Câncer. Estimativa 2018: Incidência De Câncer no Brasil. (2018 Estimatives: Cancer Incidence in Brazil). Rio de Janeiro, Brazil: INCA; 2018. http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/pele_melanoma/definicao. Accessed May 28, 2019.

24.

Ministerio da Saude. Brazilian Mortality Ratios. 2017. https://mortalidade.inca.gov.br/MortalidadeWeb/pages/Modelo04/consultar.xhtml#panelResultado. Accessed May 29, 2019.

25.

Hui

Meng

Bruera

, et al. Referral criteria for outpatient palliative cancer care: a systematic review. Oncologist. 2016;21(7):895–901.

26.

Hui

Bruera

. Integrating palliative care into the trajectory of cancer care. Nat Rev Clin Oncol. 2016;13(3):159–171.

27.

Gabriel

. Subcutaneous fluid administration and the hydration of older people. Br J Nurs. 2014;23(14):S10, S12-4.

28.

Vidal

Hui

Williams

Bruera

. A prospective study of hypodermoclysis performed by caregivers in the home setting. J Pain Symptom Manage. 2016;52(4):570–574.e9.

29.

Khan

Younger

. Promoting safe administration of subcutaneous infusions. Nurs Stand. 2007;21(31):50–56.

30.

Bruera

Legris

Kuehn

, et al. HDC for the administration of fluids and narcotic analgesics in patients with advanced cancer. J Pain Symptom Manage. 1990;5(4):218–220.

31.

Bruera

Sala

Rico

, et al. Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol. 2005;23:2366–2371.

32.

Frisoli

de Paula

Feldman

, et al. Subcutaneous hydration by HDC. A practical and low-cost treatment for elderly patients. Drugs Aging. 2000;16:313–319.

33.

Justino

Tuoto

Kalinke

, et al. Hipodermóclise em pacientes oncológicos sob cuidados paliativos [Hypodermoclysis for cancer patients under palliative care]. Cogitare Enfermagem. 2013;18(1):84–89.

34.

Pontalti

Rodrigues

ESA

Firmino

, et al. Via subcutânea: segunda opção em cuidados paliativos [Subcutaneous route: second option in palliative care]. Revista HCPA. 2012;32(2):199–207.

35.

Klepstad

Rosland

. No pain, much gain. Acta Anaesthesiol Scand. 2011;55(4):375–376.

36.

Jansen

Schaufel

Ruths

. Drug treatment at the end of life: an epidemiologic study in nursing homes. Scand J Prim Health Care. 2014;32(4):187–192.

37.

Giordano

Onyinyechi

Sara

. Hypodermoclysis: the modern use in care of an ancient therapeutic technic. J Hosp Palliat Med Care. 2018;1:003.

38.

Azevedo

Barbosa

. Manual De Cuidados Paliativos. Hipodermóclise: um método alternativo para infusão de fluidos e medicamentos pela via subcutânea. Rio de Janeiro, Brazil: Academia Nacional de Cuidados Paliativos—ANCP; 2009;186–189.

39.

Alexander

Corrigan

Gorski

Hankins

Perucca

Infusion nursing: an evidence-based approach. In: Louis

III , ed. American Association of Critical-Care Nurses. Columbia, SC: Elsevier Saunders Editore; 2010.

40.

Goarin

Cogulet

. Administration des médicaments par voiesous-cutanée em soins palliatifs [Drugs administration by subcutaneous route in palliative care]. Thérapie. 2010;65(6):525–532.

41.

Gomes

Silva

AMBD

Zago

, et al. Nursing knowledge and practices regarding subcutaneous fluid administration. Rev Bras Enferm. 2017;70(5):1096–1105.

42.

Royal Dutch Medical Association (KNMG). Guideline for palliative sedation. 2009. http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Guideline-for-palliative-sedation-2009.htm. Accessed January 2013.

43.

Fainsinger

Landman

Hoskings

, et al. Sedation for uncontrolled symptoms in a south African hospice. J Pain Symptom Manage. 1998;16(3):145–152.

44.

Chater

Viola

Paterson

, et al. Sedation for intractable distress in the dying—a survey of experts. Palliat Med. 1998;12(4):255–269.

45.

Broeckaert

Mullie

Gielen

, et al. Palliatievesedatie. richtlijn, versie: 2.0 [palliative guideline, version 2.0]. 2012. http://www.pallialine.be/accounts/129/docs/richtlijn_palliatieve_sedatie.pdf. Accessed January 2019.

46.

Cherny

Radbruch

. The board of the European association for palliative care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23:581–593.

47.

Department of Health. End of Life Care Strategy: Promoting high-quality care for all adults at the end of life. 2008. https://www.gov.uk/government/uploads/system/uploads/attachmentdata/file/136431/Endoflifestrategy.pdf. Accessed May 28, 2019.

48.

Welsh Government. Together for Health—Delivering End of Life Care: A Delivery Plan up to 2016 for NHS Wales and Its Partners; 2013. http://wales.gov.uk/docs/dhss/publications/130416careen.pdf. Accessed May 28, 2019.

49.

Woodman

Baillie

Sivell

. The preferences and perspectives of family caregivers towards place of care for their relatives at the end-of-life. A systematic review and thematic synthesis of the qualitative evidence. BMJ Support Palliat Care. 2015;0:1–12.

50.

Gomes

Calanzani

Curiale

, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochr Database Syst Rev. 2013;6(7):1–279.