1
|
Meng F, Fan S, Guo L, Jia Z, Chang H, Liu F. Incidence and risk factors of PICC-related thrombosis in breast cancer: a meta-analysis. Jpn J Clin Oncol 2024:hyae055. [PMID: 38711392 DOI: 10.1093/jjco/hyae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The incidence and risk factors of peripherally inserted central catheter-related thrombosis in patients with breast cancer have not been fully elucidated. METHOD Meta-analysis was performed by searching all studies on the incidence of peripherally inserted central catheter-associated thrombosis and risk factors for its formation in breast cancer patients from the establishment of the database to May 2023, including PubMed, Embase, Web of Science, China Knowledge Network, China Biomedical Literature Service System (SinoMed) and Wanfang databases. Then the incidence of peripherally inserted central catheter-related thrombosis and risk factors for its formation were analyzed in breast cancer patients. RESULTS A total of 15 articles were included, involving 8635 patients. The total incidence of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%) and 12.9% (95% confidence interval: 7.0-22.5%) after correction. Thirty-two risk factors were included, and eight risk factors could be combined. Among these risk factors, there were statistically significant differences (P < 0.05) in body mass index ≥ 25 (odds ratio = 6.319, 95% confidence interval: 2.733-14.613; P < 0.001), D-dimer >500 ng/ml (odds ratio = 1.436, 95% confidence interval: 1.113-1.854; P = 0.005), increased fibrinogen (odds ratio = 4.733, 95% confidence interval: 1.562-14.346; P = 0.006), elevated platelet count (odds ratio = 4.134, 95% confidence interval: 2.694-6.346; P < 0.001) and catheter malposition (odds ratio = 8.475, 95% confidence interval: 2.761-26.011; P < 0.001). CONCLUSION The incidence rate of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%). Body mass index ≥ 25, D-dimer >500 ng/ml, elevated fibrinogen, elevated platelet count and catheter malposition were risk factors for peripherally inserted central catheter-related thrombosis in breast cancer patients.
Collapse
Affiliation(s)
- Fanlun Meng
- Department of Breast Surgery, Fuyang Cancer Hospital, Fuyang, China
| | - Shujun Fan
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Lingmin Guo
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhongfeng Jia
- Department of Breast Surgery, Fuyang Cancer Hospital, Fuyang, China
| | - Hongjun Chang
- Department of Breast Surgery, Fuyang Cancer Hospital, Fuyang, China
| | - Feng Liu
- Department of Breast Surgery, Fuyang Cancer Hospital, Fuyang, China
| |
Collapse
|
2
|
Liu S, Xiang Y, Gu Y, Chen N, Fu P, Wei Y, Zhao P, Li Y, Du C, Mu W, Xia Z, Chen Y. Patient preferences and willingness to pay for central venous access devices in breast cancer: A multicenter discrete choice experiment. Int J Nurs Stud 2024; 152:104695. [PMID: 38301304 DOI: 10.1016/j.ijnurstu.2024.104695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Despite being a significant management decision in clinical or nursing practice, there is limited understanding of the preferences regarding risks, benefits, costs, and other attributes of patients with breast cancer when selecting peripherally inserted central catheters or totally implanted ports. The objective of this study is to investigate the preferences of patients with breast cancer who require chemotherapy when selecting an optimal central venous access device. METHODS Data on patients' preferences for central venous access devices were collected using a face-to-face discrete choice experiment from the oncology departments of three public hospitals in China representing the eastern (Zhejiang province), central (Henan province), and western (Sichuan province) regions. The study used six attributes to describe the preferences of breast cancer patients for central venous access devices, including out-of-pocket cost, limitations in activities of daily living, catheter maintenance frequency, risk of catheter-related thrombosis, risk of catheter-related infection, and size of incision. Data were analyzed using a conditional logit model and mixed logit model. The marginal willingness to pay (mWTP) was calculated by assessing the ratio of the preference for other attributes to the preference for out-of-pocket cost. RESULTS A total of 573 respondents completed the survey. The discrete choice experiment results showed that respondents strongly preferred a central venous access device with a catheter maintenance frequency of one time a month (vs four times a month, β = 1.188, p < 0.001), the lower risk of catheter-related thrombosis (2 % vs 10 %, β = 1.068; p < 0.001) and lower risk of catheter-related infection (2 % vs 8 % risk: β = 0.824; p < 0.001). Respondents were willing to pay CNY ¥11,968.1 (US$1776.5) for a central venous access device with a catheter maintenance frequency of one time a month rather than four times a month, ¥10,753.6 (US$1596.2) for a central venous access device with 2 % thrombosis risk over one with 10 %, and ¥8302.0 (US$1232.3) for a central venous access device with 2 % infection risk over one with 8 %. Respondents with longer travel time to the hospital, younger than 50 years old, and with urban employee basic medical insurance were willing to pay more for an improvement in the attributes. CONCLUSIONS These findings suggest that patients with breast cancer were mainly concerned with the out-of-pocket cost, catheter maintenance frequency, risk of catheter-related thrombosis and risk of catheter-related infection when choosing a central venous access device for the delivery of chemotherapy. In clinical or nursing practice, when making central venous access device recommendation for young patients and those who live far from hospitals, totally implanted ports may be a preferable choice.
Collapse
Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
| | - Yuliang Xiang
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Na Chen
- Department of Nursing, Chengdu Medical College, Chengdu 610500, China; Department of Anesthesiology, The Second Affiliated Hospital of Air Force Military Medical University, Shaanxi 710038, China
| | - Peifen Fu
- Department of Breast Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Yanan Wei
- Department of Breast Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pei Zhao
- Department of Breast Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yinfeng Li
- Department of Nursing, Sichuan Cancer Hospital, Chengdu 610042, China
| | - Chengyong Du
- Department of Breast Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Wenxuan Mu
- Department of Nursing, Chengdu Medical College, Chengdu 610500, China
| | - Zhiyuan Xia
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China.
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China.
| |
Collapse
|
3
|
Chang YL, Sae-Lim C, Lin SL, Lai HW, Huang HI, Lai YC, Chen ST, Chen DR. Scarless totally implantable venous access port (TIVAP) implantation: Surgical technique, preliminary results, learning curve, and patients-reported outcome in 125 breast cancer patients. Surg Oncol 2024; 53:102048. [PMID: 38412756 DOI: 10.1016/j.suronc.2024.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Minimal-access (endoscopic or robotic-assisted) breast surgery has been increasingly performed and shown better cosmetic results. However, location of totally implantable venous access port (TIVAP) for systemic treatment at anterior chest may compromise its aesthetic benefits. Therefore, we proposed a new scarless technique for TIVAP implantation, and reported the preliminary results, learning curve, and patients-surveyed outcome. METHODS Surgical technique of the new "scarless" TIVAP implantation was proposed. Patients receiving this procedure in a single institution were included. The preliminary results of the scarless TIVAP implantation, learning curve, and patient-reported outcome were analyzed and reported. RESULTS A total of 125 breast cancer patients received scarless TIVAP procedures were enrolled. The primary success rate of the scarless TIVAP implantation was 100%. Mean operative time was 46 ± 14 min. Mean amount of blood loss was 8.5 ± 3.2 ml. The cumulative sum plot showed operation time significantly decreased after 24th cases. In the initial learning phase, the mean operative time was 55 ± 17 min, and decreased to 43 ± 12 min in the later mature phase (P = 0.003). There were 5 (4%) complications detected, which included 1 (0.8%) seroma formation, 2 (1.6%) revisions, and 2 (1.6%) unplanned explantations. From patients-evaluated questionnaires, more than 90% of responders were satisfied with aesthetic results, experience during surgery, and application of scarless TIVAP for systemic therapy. CONCLUSIONS The scarless TIVAP implantation is a safe & reliable procedure with high patients-reported aesthetic satisfaction, and could be an alternative TIVAP procedure for patients requiring chemotherapy and desiring a less noticeable scar.
Collapse
Affiliation(s)
- Yi-Lin Chang
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Hung-Wen Lai
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan.
| | - Yuan-Chieh Lai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Shou-Tung Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| |
Collapse
|
4
|
Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
Collapse
Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| |
Collapse
|
5
|
Kurata Y, Ohira G, Hayano K, Imanishi S, Tochigi T, Takahashi Y, Mamiya H, Iwata M, Uesato M, Murakami K, Toyozumi T, Matsumoto Y, Nakano A, Otsuka R, Hayashi H, Matsubara H. Peripherally inserted central catheter securement with cyanoacrylate glue and bloodstream infection: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:215-223. [PMID: 38047542 DOI: 10.1002/jpen.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Treatment via a peripherally inserted central venous catheter is important for anticancer treatment, perioperative management, and nutrition management. In this study, we aimed to investigate the usefulness of cyanoacrylate glue (CG) in managing peripherally inserted central venous catheters in adults. METHODS This retrospective cohort study enrolled 411 adults requiring a central venous catheter for treatment in the Chiba University Esophageal-Gastro-Intestinal Surgery department between January 2021 and October 2022. The preventive effect of CG in reducing adverse events, including infection, tip migration, and thrombus formation, was evaluated by reviewing electronic medical records, chest radiographs, and contrast-enhanced computed tomography scans. RESULTS CG and other dressings were used in 158 (CG group) and 253 (control group) patients, respectively. The incidence of catheter infection based on the clinical course was lower in the CG group (3.2%) than in the control group (9.1%; P = 0.03). However, cases of infection confirmed by blood or catheter cultures did not differ between the CG (1.3%) and control (1.9%) groups (P = 1.0). Chest radiographs revealed that catheter tip migration (mean ± SD) was lesser in the CG group (8.2 ± 6.7 mm) than in the control group (15.0 ± 15.8 mm; P < 0.01). There were two cases of venous thrombus formation in the control group. CONCLUSION In a population dominated by esophago-gastroenterological malignancy, peripherally inserted central catheter securement via CG was associated with decreased catheter removal because of suspected catheter infection. Further research on larger cohorts is needed to determine if other adverse events decrease following peripherally inserted central catheter securement via CG.
Collapse
Affiliation(s)
- Yoshihiro Kurata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yumiko Takahashi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisashi Mamiya
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Moe Iwata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akira Nakano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
6
|
Rieger MJ, Schenkel X, Dedic I, Brunn T, Gnannt R, Hofmann M, de Rougemont O, Stolz SM, Rösler W, Studt JD, Balabanov S, Wicki A, Lorch A, Manz MG, Schwotzer R. Complication rates of peripherally inserted central catheters vs implanted ports in patients receiving systemic anticancer therapy: A retrospective cohort study. Int J Cancer 2023; 153:1397-1405. [PMID: 37254629 DOI: 10.1002/ijc.34612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
While implanted port catheters ("PORTs") have historically been the standard device for intravenous systemic anticancer therapy, the use of peripherally inserted central catheters (PICCs) has increased continuously and reliable catheter selection guidelines are lacking. We compare complication rates of PORTs and PICCs in cancer treatment in a retrospective study of 3365 patients with both solid organ (n = 2612) and hematologic (n = 753) malignancies, between 2001 and 2021. 26.4% (n = 890) of all patients were treated via PICCs and 73.6% (2475) via PORTs. 20.7% (578) experienced a major catheter-related complication with a higher rate in PICCs than in PORTs (23.5% vs 14.9%, P < .001). Among major complications, infections and mechanical complications were more common in PICCs than in PORTs (11.9% vs 6.4%, P = .001, 7.3% vs 4.2%, P = .002), whereas the rate of thrombosis was similar (3.4% vs 3.0%, P = .9). While PORTs had a higher rate of periprocedural complications (2.7% vs 1.1%, P < .05), PICCs overall complication rate exceeded PORTs within 3 days from implantation. Median follow-up was 49 (PICC) and 60 weeks (PORT). PORTs are safer and therefore should be preferred in this setting regardless of catheter dwell time.
Collapse
Affiliation(s)
- Max J Rieger
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Xenia Schenkel
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Ivona Dedic
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Tadeusz Brunn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ralph Gnannt
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Hofmann
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian M Stolz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
Liu R, Xu H, Pu L, Xie X, Chen H, Wu Z, Chen H, Zhang X. Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study. BMC Cancer 2023; 23:894. [PMID: 37736715 PMCID: PMC10515037 DOI: 10.1186/s12885-023-11413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy. METHODS This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis. RESULTS Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106). CONCLUSIONS PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).
Collapse
Affiliation(s)
- Ruixia Liu
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Huiqiong Xu
- Division of Abdominal Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Lihui Pu
- Menzies Health Institute & School of Nursing and Midwifery, Griffith University, Brisbane Queensland, Australia
- Griffith University, Nathan Campus, Brisbane Queensland, PO Box 4111, Australia
| | - Xiaofeng Xie
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Hongxiu Chen
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Huirong Chen
- Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China
| | - Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China.
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, No.37 Guo Xue Street, PO Box 610041, West, Chengdu, Sichuan Province, P.R. China.
| |
Collapse
|
8
|
Lin L, Li W, Chen C, Wei A, Liu Y. Peripherally inserted central catheters versus implantable port catheters for cancer patients: a meta-analysis. Front Oncol 2023; 13:1228092. [PMID: 37519803 PMCID: PMC10380996 DOI: 10.3389/fonc.2023.1228092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Background The implanted vascular access ports (PORTs) were compared with peripherally inserted central catheters (PICCs) as the administration of chemotherapy regarding different clinical effects and adverse effects. Which is better is debatable. Hence, the current study was conducted to assess the safety and efficacy of these two optimal vascular access strategies. Methods The following electronic databases were searched: PubMed, Embase, and the Cochrane Library updated in May 2023. Studies on the differences in complication rates in patients with cancer using either PICC or PORT for chemotherapy were included. Meta-analysis Revman 5.3 software was used for statistical analysis. Results A total of 22 articles were retrieved. The results suggested that PORT has a superior safety profile, with lower incidences of overall adverse effects (OR=2.72, 95% CI=1.56-4.72 P=0.0004), catheter-related thrombosis (OR=2.84, 95% CI=1.97-4.11, P<0.00001), and allergic reactions (OR=6.26, 95% CI=1.86-21.09, P=0.003) than typically expected with PICC. Moreover, PICC was non-inferior to the PORT group with respect to DVT (OR=2.00, 95% CI=0.86-4.65, P=0.11) and infection (OR=1.55, 95% CI=0.75-3.22, P=0.24). Conclusion PORT achieved safety benefits compared with chemotherapy through PICC. Therefore, PORT is regarded as safe and effective vascular access for the administration of chemotherapy. When considering economic factors and some key elements, more high-quality research would help verify these clinical benefits. Systematic review registration https://www.crd.york.ac.uk/prospero/, identififier CRD42023421690.
Collapse
Affiliation(s)
- Li Lin
- Department of Oncology, Wuhan Asia General Hospital, Wuhan, China
| | - Wei Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Chen
- Department of Oncology, Wuhan Asia General Hospital, Wuhan, China
| | - Anhua Wei
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
9
|
Puri A, Dai H, Giri M, Wu C, Huang H, Zhao Q. The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:917572. [PMID: 35958406 PMCID: PMC9360324 DOI: 10.3389/fcvm.2022.917572] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous thromboembolism (VTE) can be fatal if not treated promptly, and individual studies have reported wide variability in rates of VTE associated with peripherally inserted central catheters (PICC). We thus conducted this meta-analysis to investigate the overall incidence and risk of developing PICC-related VTE in hospitalized patients. Methods We searched PubMed, Embase, Scopus, and Web of Science databases from inception until January 26, 2022. In studies with a non-comparison arm, the pooled incidence of PICC-related VTE was calculated. The pooled odds ratio (OR) was calculated to assess the risk of VTE in the studies that compared PICC to the central venous catheter (CVC). The Newcastle-Ottawa Scale was used to assess methodological quality. Results A total of 75 articles (58 without a comparison arm and 17 with), including 109292 patients, were included in the meta-analysis. The overall pooled incidence of symptomatic VTE was 3.7% (95% CI: 3.1–4.4) in non-comparative studies. In the subgroup meta-analysis, the incidence of VTE was highest in patients who were in a critical care setting (10.6%; 95% CI: 5.0–17.7). Meta-analysis of comparative studies revealed that PICC was associated with a statistically significant increase in the odds of VTE events compared with CVC (OR, 2.48; 95% CI, 1.83–3.37; P < 0.01). However, in subgroup analysis stratified by the study design, there was no significant difference in VTE events between the PICC and CVC in randomized controlled trials (OR, 2.28; 95% CI, 0.77–6.74; P = 0.13). Conclusion Best practice standards such as PICC tip verification and VTE prophylaxis can help reduce the incidence and risk of PICC-related VTE. The risk-benefit of inserting PICC should be carefully weighed, especially in critically ill patients. Cautious interpretation of our results is important owing to substantial heterogeneity among the studies included in this study.
Collapse
Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qinghua Zhao,
| |
Collapse
|
10
|
Pénichoux J, Rio J, Kammoun L, Vermeulin T, Pepin LF, Camus V, Dubois S, Bouclet F, Alani M, Contentin N, Leprêtre S, Stamatoullas A, Lanic H, Lemasle E, Ménard AL, Lenain P, Gilles-Baray M, Georgescu D, Clatot F, Tilly H, Jardin F. Retrospective analysis of the safety of peripherally inserted catheters versus implanted port catheters during first-line treatment for patients with diffuse large B-cell lymphoma. Eur J Haematol 2022; 109:41-49. [PMID: 35285085 PMCID: PMC9313835 DOI: 10.1111/ejh.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Objectives Both peripherally inserted central catheters (PICCs) and implanted port catheters (PORTs) are commonly used for the delivery of immunochemotherapy. We compared the safety of the two types of devices in a homogeneous and monocentric population of diffuse large B‐cell lymphoma (DLBCL) patients who were treated with first‐line immunochemotherapy by evaluating the numbers of catheter‐related venous thromboses (VTs) and infections that occurred in the six months after implantation according to the type of device. Methods Using a propensity score, the adjusted relative risk (ARR) between the type of catheter and the occurrence of catheter‐related complications (infection and/or VT) of interest was retrospectively determined. Results 479 patients were enrolled (266 PORTs/213 PICCs), and 26 VTs (5.4%) and 30 infections (6.3%) were identified in the period following PICC/PORT implantation. The adjusted relative risk (ARR) of catheter‐related complications (infection and/or VT) according to the type of device was 2.6 (95% CI =1.3–5.9, p = .0075). This risk increase associated with the PICC device was significant for both infections (ARR = 3.2; 95% CI = 1.3–10.9) and thrombosis (ARR = 4; 95% CI = 1.5–11.6). Conclusion Our study supports the preferential use of PORTs for the first line of treatment for DLBCL patients.
Collapse
Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Julien Rio
- Department of Medical Informatics, Centre Henri Becquerel, Rouen, France
| | - Leila Kammoun
- Unit of Clinical Haematology, Centre Hospitalier Eure-Seine, Evreux, France
| | - Thomas Vermeulin
- Department of Medical Informatics, Centre Henri Becquerel, Rouen, France
| | | | - Vincent Camus
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Sydney Dubois
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Florian Bouclet
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | | | - Hélène Lanic
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Marie Gilles-Baray
- Department of Surgery and Anaesthesia/Intensive Care Unit, Centre Henri Becquerel, Rouen, France
| | - Dragos Georgescu
- Department of Surgery and Anaesthesia/Intensive Care Unit, Centre Henri Becquerel, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Hervé Tilly
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| |
Collapse
|
11
|
Yeow M, Soh S, Yap R, Tay D, Low YF, Ning Goh SS, Yeo CS, Lo ZJ. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg Venous Lymphat Disord 2022; 10:1184-1191.e8. [PMID: 35367407 DOI: 10.1016/j.jvsv.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Ensuring reliable central venous access with the least complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life (QoL) and cost effectiveness of different types of central venous access device (CVAD) for patients receiving chemotherapy. METHODS PubMed, EMBASE and Cochrane were searched from inception to 20th August 2021 for randomized controlled trials comparing the various CVADs [non-tunnelled central venous catheter (non-tunnelled catheter), peripherally inserted central venous catheter (PICC), totally implantable ports (PORT), and tunnelled catheter]. RESULTS A total of 11 eligible RCTs comprising 2585 patients were identified. PORT was associated with lower odds of overall complications, device removal due to complications, thrombotic and mechanical complications compared to PICC [(Odds Ratio (OR) 0.54, 95% CI 0.43 - 0.69), (OR 0.49, 95% CI 0.26 - 0.93), (OR 0.37, 95% CI 0.23 - 0.62) and (OR 0.35, 95% CI 0.13 - 0.95) respectively]. Tunnelled catheter was associated with higher odds of overall complication rate, device removal due to complications and infective complications compared to PORT [(OR 1.68, 95% CI 1.30 - 2.17), (OR 2.52, 95% CI 1.34 - 4.73), (OR 2.11, 95% CI 1.14 - 3.90) respectively]. Ranking probability based on SUCRA values indicated that PORT had the lowest probability of overall complications, removal due to complications, and thrombotic complications. CONCLUSION PORT is superior in terms of complications, QoL compared to other CVADs without compromising on cost effectiveness and should be considered the standard of care in patients receiving chemotherapy.
Collapse
Affiliation(s)
- Marcus Yeow
- Yong Loo Lin School of Medicine, National University of Singapore.
| | - Shauna Soh
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Ryan Yap
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Desiree Tay
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Yi Fen Low
- Yong Loo Lin School of Medicine, National University of Singapore
| | | | | | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| |
Collapse
|
12
|
Wang P, Soh KL, Ying Y, Liu Y, Huang X, Huang J. Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis. Thromb Res 2022; 213:34-42. [DOI: 10.1016/j.thromres.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022]
|
13
|
Bertoglio S, Annetta MG, Brescia F, Emoli A, Fabiani F, Fino M, Merlicco D, Musaro A, Orlandi M, Parisella L, Pinelli F, Reina S, Selmi V, Solari N, Tricarico F, Pittiruti M. A multicenter retrospective study on 4480 implanted PICC-ports: A GAVeCeLT project. J Vasc Access 2022; 24:11297298211067683. [PMID: 35034480 DOI: 10.1177/11297298211067683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND PICC-ports may be defined as totally implantable central venous devices inserted in the upper limb using the current state-of-the-art techniques of PICC insertion (ultrasound-guided venipuncture of deep veins of the arm, micro-puncture kits, proper location of the tip preferably by intracavitary ECG), with placement of the reservoir at the middle third of the arm. A previous report on breast cancer patients demonstrated the safety and efficacy of these devices, with a very low failure rate. METHODS This retrospective multicenter cohort study-developed by GAVeCeLT (the Italian Group of Long-Term Venous Access Devices)-investigated the outcomes of PICC-ports in a large cohort of unselected patients. The study included 4480 adult patients who underwent PICC-port insertion in five Italian centers, during a period of 60 months. The primary outcome was device failure, defined as any serious adverse event (SAE) requiring removal. The secondary outcome was the incidence of temporary adverse events (TAE) not requiring removal. RESULTS The median follow-up was 15.5 months. Device failure occurred in 52 cases (1.2%), the main causes being local infection (n = 7; 0.16%) and CRBSI (n = 19; 0.42%). Symptomatic catheter-related thrombosis occurred in 93 cases (2.1%), but removal was required only in one case (0.02%). Early/immediate and late TAE occurred in 904 cases (20.2%) and in 176 cases (3.9%), respectively. CONCLUSIONS PICC-ports are safe venous access devices that should be considered as an alternative option to traditional arm-ports and chest-ports when planning chemotherapy or other long-term intermittent intravenous treatments.
Collapse
Affiliation(s)
- Sergio Bertoglio
- Department of Surgical Sciences, University of Genova, Genova, Italy
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Fabrizio Brescia
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Alessandro Emoli
- Department of Oncology, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Fabio Fabiani
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Maria Fino
- Vascular Access Center - General Surgery Unit, University Hospital, Foggia, Italy
| | - Domenico Merlicco
- Vascular Access Center - General Surgery Unit, University Hospital, Foggia, Italy
| | - Andrea Musaro
- Department of Oncologic Gynecology, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Marina Orlandi
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Laura Parisella
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Simona Reina
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | - Valentina Selmi
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Nicola Solari
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, "A. Gemelli" University Hospital Foundation, Catholic University, Rome, Italy
| |
Collapse
|
14
|
Taxbro K, Chopra V. Appropriate vascular access for patients with cancer. Lancet 2021; 398:367-368. [PMID: 34297999 DOI: 10.1016/s0140-6736(21)00920-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA.
| |
Collapse
|
15
|
Moss JG, Wu O, Bodenham AR, Agarwal R, Menne TF, Jones BL, Heggie R, Hill S, Dixon-Hughes J, Soulis E, Germeni E, Dillon S, McCartney E. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet 2021; 398:403-415. [PMID: 34297997 DOI: 10.1016/s0140-6736(21)00766-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT. METHODS We did an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin). Adults (aged ≥18 years) receiving SACT (≥12 weeks) for solid or haematological malignancy from 18 oncology units in the UK were included. Four randomisation options were available: Hickman versus PICCs versus PORTs (2:2:1), PICCs versus Hickman (1:1), PORTs versus Hickman (1:1), and PORTs versus PICCs (1:1). Randomisation was done using a minimisation algorithm stratifying by centre, body-mass index, type of cancer, device history, and treatment mode. The primary outcome was complication rate (composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate blood, mechanical failure, and other) assessed until device removal, withdrawal from study, or 1-year follow-up. This study is registered with ISRCTN, ISRCTN44504648. FINDINGS Between Nov 8, 2013, and Feb 28, 2018, of 2714 individuals screened for eligibility, 1061 were enrolled and randomly assigned, contributing to the relevant comparison or comparisons (PICC vs Hickman n=424, 212 [50%] on PICC and 212 [50%] on Hickman; PORT vs Hickman n=556, 253 [46%] on PORT and 303 [54%] on Hickman; and PORT vs PICC n=346, 147 [42%] on PORT and 199 [58%] on PICC). Similar complication rates were observed for PICCs (110 [52%] of 212) and Hickman (103 [49%] of 212). Although the observed difference was less than 10%, non-inferiority of PICCs was not confirmed (odds ratio [OR] 1·15 [95% CI 0·78-1·71]) potentially due to inadequate power. PORTs were superior to Hickman with a complication rate of 29% (73 of 253) versus 43% (131 of 303; OR 0·54 [95% CI 0·37-0·77]). PORTs were superior to PICCs with a complication rate of 32% (47 of 147) versus 47% (93 of 199; OR 0·52 [0·33-0·83]). INTERPRETATION For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service. FUNDING UK National Institute for Health Research Health Technology Assessment Programme.
Collapse
Affiliation(s)
- Jonathan G Moss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Roshan Agarwal
- Department of Oncology, Northampton General Hospital, Northampton, UK
| | - Tobias F Menne
- Department of Haematology, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Brian L Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steve Hill
- Procedure Unit, The Christie NHS Foundation Trust, Withington, UK
| | - Judith Dixon-Hughes
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Eileen Soulis
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Elaine McCartney
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
16
|
Wu O, McCartney E, Heggie R, Germeni E, Paul J, Soulis E, Dillon S, Ryan C, Sim M, Dixon-Hughes J, Agarwal R, Bodenham A, Menne T, Jones B, Moss J. Venous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT. Health Technol Assess 2021; 25:1-126. [PMID: 34318743 DOI: 10.3310/hta25470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs). OBJECTIVES To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy. DESIGN An open, multicentre, randomised controlled trial to inform three comparisons: (1) peripherally inserted central catheters versus Hickman, (2) PORTs versus Hickman and (3) PORTs versus peripherally inserted central catheters. Pre-trial and post-trial qualitative research and economic evaluation were also conducted. SETTING This took place in 18 UK oncology centres. PARTICIPANTS Adult patients (aged ≥ 18 years) receiving chemotherapy (≥ 12 weeks) for either a solid or a haematological malignancy were randomised via minimisation. INTERVENTIONS Hickman, peripherally inserted central catheters and PORTs. PRIMARY OUTCOME A composite of infection (laboratory confirmed, suspected catheter related and exit site infection), mechanical failure, venous thrombosis, pulmonary embolism, inability to aspirate blood and other complications in the intention-to-treat population. RESULTS Overall, 1061 participants were recruited to inform three comparisons. First, for the comparison of peripherally inserted central catheters (n = 212) with Hickman (n = 212), it could not be concluded that peripherally inserted central catheters were significantly non-inferior to Hickman in terms of complication rate (odds ratio 1.15, 95% confidence interval 0.78 to 1.71). The use of peripherally inserted central catheters compared with Hickman was associated with a substantially lower cost (-£1553) and a small decrement in quality-adjusted life-years gained (-0.009). Second, for the comparison of PORTs (n = 253) with Hickman (n = 303), PORTs were found to be statistically significantly superior to Hickman in terms of complication rate (odds ratio 0.54, 95% confidence interval 0.37 to 0.77). PORTs were found to dominate Hickman with lower costs (-£45) and greater quality-adjusted life-years gained (0.004). This was alongside a lower complications rate (difference of 14%); the incremental cost per complication averted was £1.36. Third, for the comparison of PORTs (n = 147) with peripherally inserted central catheters (n = 199), PORTs were found to be statistically significantly superior to peripherally inserted central catheters in terms of complication rate (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). PORTs were associated with an incremental cost of £2706 when compared with peripherally inserted central catheters and a decrement in quality-adjusted life-years gained (-0.018) PORTs are dominated by peripherally inserted central catheters: alongside a lower complications rate (difference of 15%), the incremental cost per complication averted was £104. The qualitative work showed that attitudes towards all three devices were positive, with patients viewing their central venous access device as part of their treatment and recovery. PORTs were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. The main limitation was the lack of adequate power (54%) in the non-inferiority comparison between peripherally inserted central catheters and Hickman. CONCLUSIONS In the delivery of long-term chemotherapy, peripherally inserted central catheters should be considered a cost-effective option when compared with Hickman. There were significant clinical benefits when comparing PORTs with Hickman and with peripherally inserted central catheters. The health economic benefits were less clear from the perspective of incremental cost per quality-adjusted life-years gained. However, dependent on the willingness to pay, PORTs may be considered to be cost-effective from the perspective of complications averted. FUTURE WORK The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service. TRIAL REGISTRATION This trial is registered as ISRCTN44504648. FUNDING This project was funded by the National Institute for Health Research (NHIR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 47. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elaine McCartney
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James Paul
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Eileen Soulis
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Caoimhe Ryan
- School of Social Sciences, University of Dundee, Dundee, UK
| | - Moira Sim
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Judith Dixon-Hughes
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Tobias Menne
- Haematology, Newcastle Freeman Hospital, Newcastle upon Tyne, UK
| | - Brian Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Jonathan Moss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
17
|
Piredda A, Radice D, Zencovich C, Cerri M, Aventino L, Naccarato F, Magon G, Biffi R. Safe use of Peripherally Inserted Central Catheters for chemotherapy of solid malignancies in adult patients: A 1-year monocentric, prospectively-assessed, unselected cohort of 482 patients. J Vasc Access 2020; 22:873-881. [PMID: 33019880 DOI: 10.1177/1129729820962905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Aim of this study was to analyze the overall complication and failure rates of Peripherally Inserted Central Catheters (PICCs), in a 1-year consecutive unselected cohort of 482 adult patients, affected by non-hematological malignancies undergoing chemotherapy. METHODS Adult outpatients (aged 18-75 years), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, bearing solid tumors and candidates for intravenous chemotherapy were eligible for the study. Exclusion criteria were active infections, coagulopathy (defined as platelet count <50,000/μL and/or prothrombin time more than 18 s), life expectancy <6 months, or inability to give written informed consent. Devices were all implanted in an outpatients' hospital facility, following predefined evidence-based institutional guidelines and protocols by a PICC-dedicated team at the European Institute of Oncology in Milan, Italy, during the 12-month period from January 1 to December 31, 2019. RESULTS Five-hundred PICCs were implanted in a cohort of 482 patients during the time interval of this study. Thirty devices were overall removed (6.2%), 23 as a consequence of a complication occurred, and seven inadvertently. The inserted PICCs accounted for a total of 49,718 catheter days in situ, median duration was 85.5 days [interquartile range (IQR): 56-146]. Overall there were 42 (8.7%) complications, corresponding to 0.84 catheter-adverse events (CAE)/1000 PICC-days (95% CI: 0.61-1.14). There were N = 13 (2.7%) thromboses, N = 11 (2.3%) irreversible occlusions, N = 7 (1.5%) accidental removals, N = 5 (1.0%) infections [two Catheter Related Blood Stream Infection (CRBSI) and three exit site/local infection], N = 3 (0.6%) ruptures and N = 3 (0.6%) primary or secondary malpositions. CONCLUSION This large prospective study supports the increasing use of PICCs in adult oncology outpatients treated in specialized centers with chemotherapy for non-hematological malignancies. In this clinical setting, PICC failure occurred in 6% only of the inserted devices.
Collapse
Affiliation(s)
- Alessio Piredda
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, IRCCS, Milano, Italy
| | - Claudia Zencovich
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Martina Cerri
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Lucia Aventino
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Francesco Naccarato
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Giorgio Magon
- Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Roberto Biffi
- Division of G-I Surgery, and PICC Team/Vascular Access Service, European Institute of Oncology, IRCCS, Milano, Italy
| |
Collapse
|
18
|
Corti F, Brambilla M, Manglaviti S, Di Vico L, Pisanu MN, Facchinetti C, Dotti KF, Lanocita R, Marchianò A, de Braud F, Ferrari LAM. Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis. TUMORI JOURNAL 2020; 107:17-25. [PMID: 32529962 DOI: 10.1177/0300891620931172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. METHODS We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). RESULTS A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs (p = 0.013). No significant differences in terms of catheter-related thromboses (p = 0.676) or catheter-related infections (p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort (p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128-0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018-0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135-0.553; p < 0.0001). CONCLUSIONS This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk-benefit assessment, patient preferences, and compliance.
Collapse
Affiliation(s)
- Francesca Corti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sara Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Di Vico
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Maria Neve Pisanu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Claudia Facchinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Katia Fiorella Dotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rodolfo Lanocita
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alfonso Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | - Laura Anna Maria Ferrari
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| |
Collapse
|
19
|
Chopra V. Making MAGIC: how to improve the use of peripherally inserted central catheters. BMJ Qual Saf 2020; 29:879-882. [PMID: 32220939 DOI: 10.1136/bmjqs-2019-010640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Vineet Chopra
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|