Tailored approach to the choice of long-term vascular access in breast cancer patients

Hyangkyoung Kim,Jang-Yong Kim,Eunseon Jeong,Soo Mi Son,Sukyung Kwon,Robert Jeenchen Chen

doi:10.1371/journal.pone.0255004

Abstract

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.

Highlights

In patients with an advanced stage of breast cancer, adjuvant intravenous chemotherapy is often required to improve survival
Despite the well-recognized necessity for safe and secure venous access for intravenous chemotherapy, the choice of vascular access for breast cancer therapy varies in practice and there is a lack of consensus regarding the best choices
In the three patients with bilateral cancer, one patient’s catheter was inserted into an arm port on the right side and two patients had chest ports inserted on the left side

Summary

Introduction

In patients with an advanced stage of breast cancer, adjuvant intravenous chemotherapy is often required to improve survival. Despite the well-recognized necessity for safe and secure venous access for intravenous chemotherapy, the choice of vascular access for breast cancer therapy varies in practice and there is a lack of consensus regarding the best choices. The type of vascular access, duration of treatment, and type of chemotherapeutic regimen as well as the vessel condition of the patients are factors affecting the suitability of each option [1]. The currently available vascular access devices are a traditional peripheral intravenous line or central vascular access such as a peripherally inserted central catheter (PICC) or a surgically inserted central line to the chest (chest port) or the arm (arm port).

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Discussion

Conclusion