A COMPARATIVE STUDY OF CHEMOPORT VERSUS PERIPHERAL VENOUS ACCESS IN BREAST CANCER PATIENTS IN GOA MEDICAL COLLEGE.

Abstract

Background: Totally implantable venous access devices (TIVADs) considered standard of care for administration of intravenous chemotherapeutic drugs for patients needing long term chemotherapeutic drugs. Methodology: This prospective comparative study carried over a period 2 years in all patients diagnosed with breast cancer. Patients will be divided into 2 groups-1 group will receive chemotherapy using the chemoport and the other group through peripheral intravenous access. The group will be divided based on simple randomization on alternate basis. While the average dura Results: tion for the procedure of port insertion was 59mins, almost 90% patients were discharged within 24 hrs with no complications Of the 50 patients that underwent the procedure of chemoport implantation, 21 patients underwent by Internal Juglar Vein while the remainder by Subclavian vein out of which in 2 patients the procedure was abandoned owing to complications of migration of guide wire and hemothorax, both of which occurred while attempting subclavian catheterization. While the guide wire was retrieved under uoroscopic guidance, Intercoastal drainage tube was passed for patient with hemothorax. This complication can be avoided by using radiological guidance or under uoroscope. Of the remaining patients, 13 patients the port was removed as they had completed chemotherapy were termed disease free. While in 2 patients port was removed pre-maturely due local port site infection and generalized sepsis due to neutropenia. During the process of chemotherapy through port, 1 patient developed blockage of port as evidenced by no return ow by aspiration. This was managed by giving heparin ush and visualized under C-arm for patency. When it comes to morbidity of the port, majority of the people were in the opinion that the process of port insertion was painless, they had no sensation of foreign body, no itching/pain and did not interfere with day to day life.And on inquiring regarding the satisfaction by the patient, maximum people were of the opinion that port helped speed up chemotherapy sessions, satised with cosmesis, and preferred port over peripheral iv line. About 60% would agree to recommend port over peripheral iv line. In comparison to patients who received chemotherapy through peripheral iv line, out of 50, 11 patients had serious complication of extravasation and thrombophlebitis which required hospital admission and surgical debridement. In terms of patient morbidity, >40% experienced difculty in initiation of chemotherapy in more than 50% of cycles, 26 patients were forced to receive multiple pricks, 34 patients required a second iv line to complete the session in half the cycles and 10 patients required iv at the leg/neck as others were inaccessible. High satisfaction rate Conclusion: observed in patients using chemoports for chemotherapy-it speeded up the sessions, less painful and only few people felt its presence affecting cosmesis/ day-to-day activities. It avoids the blunt of undergoing painful process of multiple pricks, use of 2nd line, thrombophlebitis and prolonged sessions seen in peripheral IV lines. Although the procedure of port implantation has got serious complications, the rate is minimal and with the help of radiological tools and surgical expertise, these can be made negligible. The only set-back by using a port is the maintenance part, which requires periodic ushing with heparinized saline to prevent blockage when not in use for prolong period (>4weeks). And so, it is advisable to remove the port promptly after completion of treatment if patient is labelled cured. Complications like infection can be avoided by strict aseptic precautions taken while handling the port for chemotherapy sessions by trained personal. Above all patient education and compliance is utmost important to ensure proper functioning of the port.