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Dos Santos BN, Beato BVG, Ferreira EB, Braga FTMM, Dos Reis PED, Silveira RCDCP. Prevalence of PICC-related thrombosis in patients with hematological malignancies: a systematic review. Support Care Cancer 2024; 32:462. [PMID: 38922487 DOI: 10.1007/s00520-024-08636-7] [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: 11/06/2023] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies. METHODS A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting. RESULTS In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%). CONCLUSION Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.
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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.
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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.
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Heggie R, Jaiswal N, McCartney E, Moss J, Menne T, Jones B, Boyd K, Soulis E, Hawkins N, Wu O. Central Venous Access Devices for the Delivery of Systemic Anticancer Therapy: An Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:7-14. [PMID: 37844662 DOI: 10.1016/j.jval.2023.09.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Patients undergoing long-term anticancer therapy typically require one of 3 venous access devices: Hickman-type device (HICK), peripherally inserted central catheter (PICC), or implantable chest wall port (PORT). Recent evidence has shown PORT is safer and improves patient satisfaction. However, PORT did not show improvement in quality-adjusted life-years and was more expensive. Decisions regarding cost-effectiveness in the United Kingdom are typically informed by a cost-per-quality-adjusted life-year metric. However, this approach is limited in its ability to capture the full range of relevant outcomes, especially in the context of medical devices. This study assessed the potential cost-effectiveness of HICK, PICC, and PORT in routine clinical practice. METHODS This is a cost-consequence analysis to determine the trade-offs between the following outcomes: complication, infection, noninfection, chemotherapy interruption, unplanned device removals, health utilities, device insertion cost, follow-up cost, and total cost, using data from the Cancer and Venous Access clinical trial. We conducted value of implementation analysis of a PORT service. RESULTS PORT was superior in terms of overall complication rate compared with both HICK (incidence rate ratio 0.422; 95% CI 0.286-0.622) and PICC (incidence rate ratio 0.295; 95% CI 0.189-0.458) and less likely to lead to an unplanned device removal. There was no difference in chemotherapy interruption or health utilities. Total cost with device in situ was lower on PORT than HICK (-£98.86; 95% CI -189.20 to -8.53) and comparable with PICC -£48.57 (95% CI -164.99 to 67.86). Value of implementation analysis found that PORT was likely to be considered cost-effective within the National Health Service. CONCLUSION Decision makers should consider including PORT within the suite of venous access devices available within in the National Health Service.
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Affiliation(s)
- Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
| | - Nishant Jaiswal
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Elaine McCartney
- Glasgow Oncology Clinical Trials Unit (GO CTU) and School of Cancer Studies, University of Glasgow, Glasgow, Scotland, UK
| | - Jon Moss
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Tobias Menne
- Haematology Department, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals, Newcastle, England, UK
| | - Brian Jones
- School of Infection and Immunity, University of Glasgow, Glasgow, Scotland, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Eileen Soulis
- Glasgow Oncology Clinical Trials Unit (GO CTU) and School of Cancer Studies, University of Glasgow, Glasgow, Scotland, UK
| | - Neil Hawkins
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Rincon-Torroella J, Molin MD, Mog B, Han G, Watson E, Wyhs N, Ishiyama S, Ahmedna T, Minn I, Azad NS, Bettegowda C, Papadopoulos N, Kinzler KW, Zhou S, Vogelstein B, Gabrielson K, Sur S. ME3BP-7 is a targeted cytotoxic agent that rapidly kills pancreatic cancer cells expressing high levels of monocarboxylate transporter MCT1. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.23.550207. [PMID: 37546808 PMCID: PMC10401962 DOI: 10.1101/2023.07.23.550207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Nearly 30% of Pancreatic ductal adenocarcinoma (PDAC)s exhibit a marked overexpression of Monocarboxylate Transporter 1 (MCT1) offering a unique opportunity for therapy. However, biochemical inhibitors of MCT1 have proven unsuccessful in clinical trials. In this study we present an alternative approach using 3-Bromopyruvate (3BP) to target MCT1 overexpressing PDACs. 3BP is a cytotoxic agent that is known to be transported into cells via MCT1, but its clinical usefulness has been hampered by difficulties in delivering the drug systemically. We describe here a novel microencapsulated formulation of 3BP (ME3BP-7), that is effective against a variety of PDAC cells in vitro and remains stable in serum. Furthermore, systemically administered ME3BP-7 significantly reduces pancreatic cancer growth and metastatic spread in multiple orthotopic models of pancreatic cancer with manageable toxicity. ME3BP-7 is, therefore, a prototype of a promising new drug, in which the targeting moiety and the cytotoxic moiety are both contained within the same single small molecule. One Sentence Summary ME3BP-7 is a novel formulation of 3BP that resists serum degradation and rapidly kills pancreatic cancer cells expressing high levels of MCT1 with tolerable toxicity in mice.
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Munoz-Mozas G, Fairhurst C, Clare S. Case Studies. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S11-S15. [PMID: 37036821 DOI: 10.12968/bjon.2023.32.sup7.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Gema Munoz-Mozas
- Vascular Access Advanced Nurse Practitioner and Lead Vascular Access Nurse, Royal Marsden NHS Foundation Trust
| | - Colin Fairhurst
- Vascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS Trust
| | - Simon Clare
- Research and Practice Development Director, the Association for Safe Aseptic Practice
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van den Bosch CH, Spijkerman J, Wijnen MHWA, Hovinga ICLK, Meyer-Wentrup FAG, van der Steeg AFW, van de Wetering MD, Fiocco M, Morsing IE, Beishuizen A. Central venous catheter-associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice. Support Care Cancer 2022; 30:8069-8079. [PMID: 35776186 PMCID: PMC9512752 DOI: 10.1007/s00520-022-07256-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/23/2022] [Indexed: 01/28/2023]
Abstract
Purpose The purpose of this study was to determine the most optimal central venous catheter (CVC) for pediatric patients with Hodgkin lymphoma (HL) in terms of complications. Methods A retrospective study including patients diagnosed with HL from 2015 to 2021 at the Princess Máxima Center was performed. Patients were followed from CVC insertion until removal or 06–2021, whichever came first. The primary outcome was the CVC-related complication incidence rate (IR) per 1000 CVC-days. Furthermore, the incidence rate ratio (IRR) was calculated by comparing complication IRs between peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP). Additionally, risk factors for central venous thrombosis (CVT) were identified. Results A total of 98 patients were included. The most frequently observed complications were local irritation/infections (18%; IR 0.93), malfunctions (15%; IR 0.88), and CVC-related CVTs (10%; IR 0.52). Single lumen PICCs were associated with a higher risk of complications (49% vs. 26%; IRR 5.12, CI95% 2.76–9.50), severe complications (19% vs. 7%; IRR 11.96, CI95% 2.68–53.42), and early removal (18% vs. 7%; IRR 9.96, CI95% 2.18–45.47). A single lumen PICC was identified as a risk factor for CVC-related CVT when compared to TIVAPs (12% vs. 7%, IRR 6.98, CI95% 1.45–33.57). Conclusion The insertion of a TIVAP rather than a PICC should be recommended for pediatric patients with HL, especially in the presence of CVT-related risk factors. Future trials should evaluate the efficacy and safety of direct oral anticoagulants for the primary prevention of CVT in pediatric patients with a PICC and other CVT-related risk factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07256-3.
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Affiliation(s)
| | - Judith Spijkerman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Idske C L Kremer Hovinga
- Van Creveldkliniek University Medical Centre Utrecht, Thrombosis and Hemostasis, Benign Hematology, Utrecht, The Netherlands
| | | | | | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Mathematical Institute, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Indra E Morsing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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