Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies

Abstract

Aims

The aim of this study was to analyze patients’ port-related quality of life.

Patients and methods

260 consecutive patients with gynecological or breast malignancies were asked to take part in a questionnaire-based survey including 26 questions, and 232 women agreed to participate in the study. The questionnaire inquired about port-related aspects of everyday life and the use of a central venous access port device for chemotherapy and supportive cancer care. Multivariate analysis was used to identify parameters associated with satisfaction and dissatisfaction in relation to the port.

Results

Most of the women were very satisfied with the use of a port to provide venous access for chemotherapy and supportive cancer care. Faster hospital procedures, good cosmetic results, and the ability to cope with the social environment had a significant influence on the degree of satisfaction. Fear of port punctures, inconvenient heparinization of the port, and fear of complications were found to be negative variables associated with the method.

Conclusions

Port catheters are well accepted by patients for chemotherapy and supportive cancer care. Generally ports should be rapidly removed after the end of antineoplastic treatment in order to improve patients’ satisfaction with the procedure.

Introduction

Central venous access port devices (CVAPDs) have been used in oncology for more than 20 years. They were first described in 1982.¹ In clinical practice, ports are most commonly used for the administration of long-term chemotherapy, transfusions, parenteral nutrition, blood sampling, pain therapy, and supportive cancer care involving the monthly application of intravenous bisphosphonates, for example.2, 3

The most common reason for implantation is the need to obtain secure venous access for cytotoxic oncological therapy.2, 4, 5, 6 In the treatment of breast cancer, chemotherapy regimens with a duration of up to 6 months are commonly required.⁷ Secure venous access is desirable for these treatments, as venous integrity may be compromised by cytostatic agents that are toxic to the veins.

The use of CVAPDs to improve the reliability of venous access, to reduce the discomfort, anxiety, and pain associated with repeated venous puncture and to avoid cancer-related morbidity has been debated.6, 8 Various types of indwelling catheter, such as externalized central venous catheters of the Hickman or Broviac type, and fully implantable central venous access ports are available for long-term venous access.9, 10, 11, 12 These systems can be placed in various vessels, such as the subclavian vein, the jugular vein, or the upper extremity veins. Totally implantable venous access port systems have several advantages over externalized indwelling catheter systems. They require only monthly flushing with heparinized solutions and are associated with fewer restrictions on activities such as bathing. In addition, the venous access is protected by the patient's skin when the port is not in use.

However, the use of CVAPD is associated with a number of complications associated with the surgery. Overall complication rates in the range of 1.8–14.4% have been reported.2, 13, 14, 15 Common complications are infections and deep venous thromboses in the upper extremity.2, 16, 17 In comparison with externalized systems, ports are associated with a lower incidence of infections and malfunctioning.¹⁶ Further complications include drug extravasation, port occlusion, catheter misplacement, pneumothorax, hematothorax, air embolism, injury to adjacent anatomic structures, disconnection, and port-membrane rupture.3, 16, 17

The overall quality of life (QoL) has been described previously in a group of patients with solid tumors.⁶ To date, there have been no reports describing port-specific aspects of QoL. The aim of the present study was to investigate these port-specific aspects and to correlate them to the complications associated with the CVAPD.