A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric Italian experience

Correlations between activation, family adaptation, and self-perceived burden in breast cancer patients with an implanted venous access port: A cross-sectional study

We found that activation and family adaptation on the self-perceived burden of breast cancer patients with an implanted venous access port (IVAP), and to analyze the correlations among these scores. A total of 256 patients completed a general data questionnaire, the Patient Activation Measure (PAM), the Family adaptation and Cohesion Scale II-Chinese version (FACES-II-CV), and the Self-perceived Burden Scale (SPBS). The total scores for activation, family adaptation, and self-perceived burden were 63.31 ± 18.92, 42.72 ± 7.937, and 28.55 ± 7.89, respectively. We analyzed activation and family adaptation were associated with self-perceived burden (P < .05) the patients' self-perceived burden main factors is included Main caregiver, disease stage, complications, Type of health insurance, activation, and family adaptation. The activation, family adaptation, and self-perceived burden of breast cancer patients with an IVAP are closely related, which suggests that clinical workers should consider the patient family to formulate an intervention plan to improve patient activation, and thus reduce the self-perceived burden. For example, hospitals regularly conduct breast cancer health education activities, or invite psychological counselors to provide services to patients.

Peripherally inserted central catheters versus implantable port catheters for cancer patients: a meta-analysis

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.

Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model

BACKGROUND

Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients.

METHODS

This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed.

RESULTS

A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis).

CONCLUSION

This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen.

Applicability of TIVAP versus PICC in non-hematological malignancies patients: A meta-analysis and systematic review

BACKGROUND

Applicability of totally implantable venous access port (TIVAP) and peripherally inserted central venous catheter (PICC) in non-hematological malignancies patients remains controversial.

METHODS

A systematic studies search in the public databases PubMed, EMBASE, Wan Fang, CNKI (China National Knowledge Infrastructure), the Cochrane Library and Google Scholar (updated to May 1, 2020) was performed to identify eligible researches. All statistical tests in this meta-analysis were performed using Stata 12.0 software (Stata Corp, College Station, TX). A P value less than 0.05 was considered statistically significant.

RESULTS

Thirteen studies were included in this final meta-analysis. The pooled data showed that compared with PICC, TIVAP was associated with a higher first-puncture success rate (OR:2.028, 95%CI:1.25-3.289, P<0.05), a lower accidental removal rate (OR:0.447, 95%CI:0.225-0.889, P<0.05) and lower complication rates, including infection (OR:0.570, 95%CI: 0.383-0.850, P<0.05), occlusion (OR:0.172, 95%CI:0.092-0.324, P<0.05), malposition (OR:0.279, 95%CI:0.128-0.608, P<0.05), thrombosis (OR:0.191, 95%CI, 0.111-0.329, P<0.05), phlebitis (OR:0.102, 95%CI, 0.038-0.273, P<0.05), allergy (OR:0.155, 95%CI:0.035-0.696, P<0.05). However, no difference was found in catheter life span (P>0.05) and extravasation (P>0.05). Moreover, TIVAP is more expensive compared with PICC in six-month use (weighted mean difference:3.132, 95%CI:2.434-3.83, P<0.05), but is much similar in 12 months use (P>0.05).

CONCLUSION

For the patients with non-hematological malignancies, TIVAP was superior to PICC in the data related to placement and the incidence of complications. Meanwhile, TIVAP is more expensive compared with PICC in six-month use, but it is much similar in twelve-month use.

Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis

BACKGROUND

Peripherally inserted central catheters (PICCs) and implantable port catheters (IPCs) are 2 most common central venous access for cancer patients receiving chemotherapy. However, no specific evidence exists to guide practitioners on safety and less cost.

OBJECTIVE

To compare the differences of complications and costs of PICC and IPC in the treatment of cancer patients with chemotherapy and to provide a basis for better clinical decision making.

METHODS

All the cohort studies were searched in the Cochrane Library, JBI, PubMed, Elsevier, Web of Science, CINAHL, CBM, and CNKI from inception to July 2018. Two reviewers screened and selected trials, evaluated quality, and extracted data. Meta-analysis and description of the outcomes were performed by using the RevMan 5.3 software.

RESULTS

A total of 761 articles were retrieved, with 15 articles meeting eligibility criteria. Outcome analysis showed no difference in 1-puncture success rate. Peripherally inserted central catheter use was associated with higher complication rates than IPC, including occlusion, infection, malposition, catheter-related thrombosis, extravasation, phlebitis, and accidental removal rate. The life span of IPC was longer than that of PICC, and the costs of IPC were lower.

CONCLUSIONS

Implantable port catheter has advantages over PICC in reducing cancer patients' complications and less cost in terms of long-term cancer chemotherapy.

IMPLICATIONS FOR PRACTICE

In terms of safety, the results provide evidence for practitioners to choose which type of central venous catheters is better for cancer chemotherapy patients. In terms of costs, practitioners need to make decisions about which type of central venous catheters has less cost.

Peripherally inserted central catheter versus totally implanted venous port for delivering medium- to long-term chemotherapy: A cost-effectiveness analysis based on propensity score matching

BACKGROUND

Peripherally inserted central catheters (PICCs) and totally implanted vascular access ports (PORTs) have been widely used for medium- to long-term chemotherapy. PICCs are associated with lower insertion cost, but higher complication rates than PORTs. However, there is a paucity of cost-effectiveness comparisons between the devices. We aimed to compare the cost-effectiveness of PICCs and PORTs for medium- to long-term chemotherapy from catheter insertion to removal.

METHODS

A cost-effectiveness analysis was conducted based on propensity score matching (PSM) from the hospital perspective. Data were collected from a retrospective cohort study. The total cost outcome comprised insertion, maintenance, removal and complication costs. The effectiveness outcome was the complication-free rate. The primary and supplemental outcomes were cost-effectiveness ratios (CERs) and incremental cost-effectiveness ratios (ICERs).

RESULTS

A total of 1050 patients (after PSM for 417 patients) were included. The average total cost for 3-6 month ($603.55 ± 78.68 vs $1270.21 ± 128.84), 6-9 month ($731.40 ± 42.97 vs $1414.48 ± 155.43), and 9-12 month ($966.83 ± 53.78 vs $1587.76 ± 160.56) dwell times were all significantly lower for PICCs than for PORTs (p < 0.001). PICCs were associated with significantly lower complication-free rates than PORTs during the 3-6 month (65.22% vs 90.58%, p < 0.001), 6-9 month (53.33% vs 91.80%, p < 0.001), and 9-12 month (44.44% vs 88.46%, p = 0.015) dwell times. Ultimately, PICCs were associated with lower CERs than PORTs for the 3-6 month (928.54 vs 1395.84) and 6-9 month (1380.00 vs 1537.48) but higher CER for the 9-12 month (2197.34 vs 1804.27) dwell times. ICERs were 2564.08 and 1751.49 with dwell times of 3-6 months and 6-9 months, respectively.

CONCLUSION

This study provided economic evidence that informs vascular access device choice for medium- to long-term chemotherapy. For 3-9 month dwell times, PICCs were more cost-effective than PORTs. Furthermore, ICERs were applied and the choice was determined by willingness-to-pay. For 9-12 month dwell times, PORTs might be more cost-effective than PICCs, and studies with larger sample size would be needed to verify this finding in the future.

Economic evaluation of peripherally inserted central catheter and other venous access devices: A scoping review

OBJECTIVE

With the widespread use of peripherally inserted central catheters, plenty of studies have compared peripherally inserted central catheters with other venous access devices to choose the most appropriate device in different clinical scenarios. Economic attributes are one of the important influencing factors in the selection of venous access devices. Several economic evaluation studies have been conducted in this area, but the evaluation methods, contents, outcomes, and quality of these economic studies have not been systematically evaluated. Therefore, we aimed to map the existing research on the economic evaluations of peripherally inserted central catheters and other venous access devices to provide economic evidence for decision-makers to choose a suitable venous access device. Second, we appraised the quality of economic evaluation studies in this area to highlight methodological weaknesses and provide an outline for the normative application of this methodology for future research.

METHODS

A literature search was undertaken through 11 databases from inception until 11 March 2019, to identify economic evaluation studies comparing peripherally inserted central catheters with other venous access devices. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included studies and appraised their methodological quality using the Joanna Briggs Institute critical appraisal checklist for economic evaluations.

RESULTS

A total of 16 studies were included. Among the six studies comparing peripherally inserted central catheters with peripheral intravenous catheters, four studies performed a cost-effectiveness analysis and noted that peripherally inserted central catheters were more cost-effective than peripheral intravenous catheters. Two studies performed a cost analysis to compare peripherally inserted central catheters with peripheral intravenous catheters during the insertion and maintenance/removal periods but reached different conclusions. Seven of the included studies performed a cost analysis to compare peripherally inserted central catheters with central venous catheters. They pointed out that the catheter insertion costs of peripherally inserted central catheters were lower than those for central venous catheters in developed countries, whereas the opposite conclusion was reached in developing countries. Conversely, conclusions regarding the costs for catheter maintenance and catheter insertion and maintenance/removal were inconsistent. Six of the included studies performed a cost analysis to compare peripherally inserted central catheters with vascular access ports. They pointed out that the insertion costs of peripherally inserted central catheters were lower than those for vascular access ports, and the maintenance costs were higher than those for vascular access ports. Conversely, conclusions regarding the costs for catheter insertion and maintenance/removal were inconsistent. In addition, the methodological quality of the included studies had plenty of deficiencies, including no discounting, no sensitivity analysis, no incremental analysis, a lack of validity of costs and effectiveness, and so on.

CONCLUSION

This scoping review highlighted the desperate paucity of economic evaluation studies of peripherally inserted central catheters and other venous access devices in amount, evaluation contents, and economic evaluation methods. The conclusions of the cost-effectiveness analysis of peripherally inserted central catheters with other venous access devices were consistent. Conversely, the conclusions of the cost analysis of peripherally inserted central catheters with other venous access devices were inconsistent mainly in the comparison of peripherally inserted central catheters with peripheral intravenous catheters, central venous catheters, and vascular access ports during the insertion and maintenance/removal periods. This review also highlighted many methodological issues of economic evaluations in this area. Therefore, it is necessary to conduct more high-quality economic evaluation studies on peripherally inserted central catheters and other venous access devices by performing cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis from catheter insertion to removal to provide evidence for clinical practitioners, patients, and decision-makers to choose a suitable venous access device in different clinical scenarios.

Safety and efficacy of trabectedin when administered in the inpatient versus outpatient setting: Clinical considerations for outpatient administration of trabectedin

Background

The results of the randomized, phase 3 ET743‐SAR‐3007 trial demonstrated that trabectedin had a significantly longer progression‐free survival (PFS) compared with dacarbazine in patients with advanced leiomyosarcoma/liposarcoma after the failure of prior chemotherapy. Patients randomized to trabectedin received a 24‐hour intravenous infusion either in an inpatient or outpatient setting. Herein, the authors reported the safety, efficacy, and patient‐reported outcomes based on first infusion site of care.

Methods

Patients were randomized 2:1 to trabectedin (at a dose of 1.5 mg/m²) or dacarbazine (1 g/m² over 20‐120 minutes) with overall survival (OS) as the primary endpoint and PFS, time to disease progression, objective response rate, duration of response, safety, and patient‐reported symptom scoring as secondary endpoints. The setting of the trabectedin infusion was based on institutional preference and categorized based on the setting of the first infusion.

Results

Of the 378 patients who were treated with trabectedin, 100 (27%) and 277 (73%), respectively, first received trabectedin in the inpatient and outpatient setting. No differences were observed with regard to PFS or OS based on site of care. The median PFS was 4.1 months versus 4.2 months (hazard ratio, 0.90; P = .49) for inpatients versus outpatients, respectively, and the median OS was 14.3 months versus 13.7 months (hazard ratio, 0.89; P = .40), respectively. Grade 3/4 adverse events (classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]) were reported in 87 inpatients (87%) compared with 219 outpatients (79%); grade 3/4 serious adverse events were reported in 43 inpatients (43%) and 92 outpatients (33%). Extravasation occurred in 0 inpatients and 5 outpatients (2%), whereas the incidence of catheter‐related complications was similar between groups (16% vs 15%).

Conclusions

Although the majority of patients who were randomized to trabectedin received outpatient therapy, the outcomes of the current study suggested equivalent safety and efficacy in either setting.

The majority of patients randomized to trabectedin in the ET743‐SAR‐3007 trial have received the drug in the outpatient setting. The results of the current analysis suggest that trabectedin has equivalent efficacy and comparable safety when administered in an inpatient or outpatient setting.

Hot Compress with Chinese Herbal Salt Packets Reducing PICC Catheter Complications: A Randomized Controlled Trial

OBJECTIVE

To explore the preventive effect of applying hot compress with Chinese herbal salt packets (CHSP) to puncture vessels under aseptic conditions during peripherally inserted central catheter (PICC) on postoperative phlebitis.

METHODS

A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups (360 cases each group) according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP (which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g) on the punctured vessel under aseptic conditions for 5-10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization.

RESULTS

The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [(7.96±0.42) mm vs. (4.39±0.54) mm, P<0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00% (329/350) vs. 73.72% (244/329), P<0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group (P=0.007). There was no adverse event with CHSP.

CONCLUSION

Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization (Trial registration No. ChiCTR-ONC-17010498).

Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters

BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6 mmol/L). Furthermore, the duration of calcium supplementation was 71.62 ± 4.48 hours in PICC group and 100.4 ± 5.43 hours in CVC group (P < 0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.

Central venous access related adverse events after trabectedin infusions in soft tissue sarcoma patients; experience and management in a nationwide multi-center study

BACKGROUND

Trabectedin has shown efficacy against soft tissue sarcomas (STS) and has manageable toxicity. Trabectedin is administered through central venous access devices (VAD), such as subcutaneous ports with tunneled catheters, Hickman catheters and PICC lines. Venous access related adverse events are common, but have not yet been reported in detail.

METHODS

A retrospective analysis of patient files of STS patients receiving trabectedin monotherapy between 1999 and 2014 was performed in all five STS referral centers in the Netherlands. This survey focused on adverse events related to the VAD and the actions taken in response to these events.

RESULTS

In the 127 patients included in this analysis, 102 venous access ports (VAP), 15 Hickman catheters and 10 PICC lines were used as primary means of central venous access. The most frequently reported adverse events at the VAD site were erythema (30.7%), pain (28.3%), inflammation (11.8%) and thrombosis (11.0%). Actions taken towards these adverse events include oral antibiotics (17.3%), VAD replacement (15.0%) or a wait-and-see policy (13.4%). In total, 45 patients (35.4%) with a subcutaneous port developed a varying degree of inflammation along the trajectory of the tunneled catheter. In all but three patients, this was a sterile inflammation, which was considered a unique phenomenon for trabectedin. Microscopic leakage of trabectedin along the venous access device and catheter was considered the most plausible cause for this adverse event. Placing the catheter deeper under the skin resolved the issue almost completely.

CONCLUSION

Trabectedin infusion commonly leads to central venous access related adverse events. Sterile inflammation along the catheter trajectory is one of the most common adverse events and can be prevented by placing the catheter deeper under the skin.

Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

BACKGROUND

Central venous catheters (CVCs) have been an effective access for chemotherapy instead of peripherally intravenous catheters. There were limited studies on the choices and effects of different types of CVCs for chemotherapy. The aim of this study was to compare the complications, cost, and patients' quality of life and satisfaction of three commonly used CVCs for chemotherapy, such as implanted venous port, peripherally inserted central catheters (PICCs), and external non-tunneled central venous catheters (NTCs).

METHODS

A double-center prospective cohort study was carried out from March 2014 to December 2016. Catheterization situation, complications, catheter maintenance, cost, and patients' quality of life and satisfaction were recorded, investigated, and analyzed. Forty-five ports, 60 PICCs and 40 NTCs were included. All the CVCs were followed up to catheter removal.

RESULTS

There was no statistical difference in catheterization success rates between port and PICC. NTC had less success rate by one puncture compared with port. Ports had fewer complications compared with PICCs and NTCs. The complication rates of ports, PICCs and NTCs were 2.2%, 40%, and 27.5%, respectively. If the chemotherapy process was <12 months, NTCs cost least, and the cost of port was much higher than PICC and NTC. When the duration time was longer than 12 months, the cost of port had no difference with the cost of PICC. Quality of life and patients' satisfaction of port group were significantly higher than the other two groups.

CONCLUSION

Although port catheterization costs more and needs professional medical staff and strict operational conditions, ports have fewer complications and higher quality of life and patients' satisfaction than PICCs and NTCs. Therefore, not following consideration of the economic factor, we recommend port as a safe and an effective chemotherapy access for cancer patients, especially for whom needing long chemotherapy process.

Extravasation emergencies: state-of-the-art management and progress in clinical research

In cancer treatment, extravasation is defined as an inadvertent instillation or leakage of cytotoxic drugs into the perivascular space during infusion. As a dreaded complication of chemotherapy, extravasation has gained increasing attention in recent years. Classified according to their subcutaneous toxicity, three types of cytotoxins have been established: vesicants, irritants and nonvesicant drugs. Vesicant cytotoxic drugs may induce tissue damage, ulceration and tissue necrosis. Although we have established measures to manage extravasation emergencies, prevention is of paramount importance. This may be achieved within hospitals through regular training and education, which is best provided by a specialised and experienced task force including all disciplines involved in cancer therapy. Moreover, clinical and translational studies contribute to a better management of chemotherapy-induced extravasation as shown by our group in recent years. We were able to demonstrate that the evaluation of blood flow by indocyanine green angiography in the extravasation area predicts the extent of damage and the need of future surgical intervention. When a Port-a-Cath® extravasation is detected early, a subcutaneous wash-out procedure was found to be beneficial, corroborated by the analytical evaluation of the removed cytotoxic compound epirubicin. In another study, the tissue distribution of platinum was quantified at the anatomic level in cryosections of various tissues. This novel knowledge complements and supports our current efforts to handle extravasations better. On the other hand, a number of new drugs (chemotherapy, monoclonal antibodies, checkpoint inhibitors etc.) with many open issues to reliably classify their tissue toxicity still require our attention.