The Development and Testing of a Chemotherapy-Induced Phlebitis Severity (CIPS) Scale for Patients Receiving Anthracycline Chemotherapy for Breast Cancer.

Valerie Harris,Rosie Roberts,Gina Dolan,Meinir Hughes,E Mark Williams

doi:10.3390/jcm9030701

Valerie Harris, Rosie Roberts + Show 3 more

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https://doi.org/10.3390/jcm9030701

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Abstract

A chemotherapy induced phlebitis severity (CIPS) scale was developed in patients receiving anthracycline chemotherapy for breast cancer. A five-point severity scoring scale for chemotherapy-induced phlebitis was tested for inter-rater reliability. Ease of use was observed through timing assessments and a review of the completeness of documentation. A comparison of CIPS scale grade with participant reported severity scores was made. The final version was tested for inter-rater reliability, with 122 patient assessments. There was an 89.3% (109 of 122) agreement between the assessors (κ = 0.82, SE ± 0.042, 95% CI 0.74–0.90). Mean time to complete the scale was 1 min 36 s and documentation was fully completed for 98% of assessments. Patient reported severity closely matched the CIPS grade (κ = 0.54, SE ± 0.045, 95% CI 0.46–0.63). This new scale provides a list of symptoms associated with chemotherapy phlebitis, which can be scored quickly and accurately. It provides a reliable method for assessing chemotherapy-induced phlebitis, enabling a better understanding of its impact on patients’ quality of life, and to inform the appropriate choice of peripheral or central intravenous administration. Multicentre testing of the CIPS scale is recommended.

Highlights

Despite the use of new targeted therapies and improved cancer detection, chemotherapy treatment continues to play a major role in cancer treatment [1]
This study aims to develop a chemotherapy induced phlebitis severity (CIPS) scale, which provides a comprehensive and reliable measure of the severity of chemotherapy-induced phlebitis, which can be used to help assess the impact on patients and inform the choice of intravenous access
The final wording chosen to describe the effect on function in the CIPS scale was influenced by the National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE), which uses the effect of symptoms on activities of daily living (ADL) as a key measure to indicate the severity and impact of symptoms on patients [20]

Summary

Introduction

Despite the use of new targeted therapies and improved cancer detection, chemotherapy treatment continues to play a major role in cancer treatment [1]. One recognised consequence of peripheral administration of some intravenous chemotherapy is venous irritation leading to phlebitis and thrombophlebitis resulting from the chemical effects of the drug on the vein wall [2,3]. Chemical phlebitis causes symptoms such as pain, swelling, redness and, at worst, hardening and sclerosis of the vein resulting in a palpable venous cord and thrombosis of the upper extremity veins [4,5]. It has been recommended that a central venous catheter (CVC) should be used for the administration of drugs which are known to cause significant venous irritation and phlebitis [6]. The decision to place a CVC needs to be carefully assessed, taking into consideration the risk of infection and thrombosis associated with central line placement [7], compared with the severity and impact of phlebitis

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