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Optimal vascular access strategies for patients receiving chemotherapy for early-stage breast cancer: a systematic review

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Abstract

Importance

Systemic chemotherapy can be administered either through a peripheral vein (IV), or centrally through peripherally inserted central catheter (PICC), totally implanted vascular access devices (PORTs) or tunnelled cuffed catheters. Despite the widespread use of systemic chemotherapy in patients with breast cancer, the optimal choice of vascular access is unknown.

Objective

This systematic review evaluated complication rates and patient satisfaction with different access strategies for administering neo/adjuvant chemotherapy for breast cancer.

Evidence reviewed

Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials were searched from 1946 to September 2017. Two reviewers independently assessed each citation. The Newcastle–Ottawa scale was used to assess the quality of cohort and case–control studies.

Findings

Of 1584 citations identified, 15 unique studies met the pre-specified eligibility criteria. There were no randomised studies comparing types of vascular access. Reports included six single-institution retrospective cohort studies, one retrospective multi-institution cohort, one retrospective cohort database study, five prospective single-institution studies, one prospective multi-institution study and one nested case–control study. Median complication rates were infection: 6.0% PICC (2 studies) versus 2.1% PORT (8 studies); thrombosis: 8.9% PICC (2 studies) versus 2.6% PORT (9 studies); extravasation: 0 PICC (1 study) versus 0.4% PORT (4 studies) and mechanical issues: PICC 3.8% (1 study) versus 1.8% PORT (9 studies). Satisfaction/quality of life appeared high with each device.

Conclusion

In the absence of high-quality data comparing vascular access strategies, randomised, adequately powered, prospective studies would be required to help inform clinical practice and reduce variation.

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Acknowledgements

Internal funding was used for this study from the Rethinking Clinical Trials (REaCT) program.

Funding

Funding for this study was through the Rethinking Clinical Trials (REaCT) program.

Author information

Authors and Affiliations

  1. Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, Canada

    Andrew Robinson, Osama Souied & Dalia Kamel

  2. Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada

    A. Brianne Bota, Carol Stober, John Hilton, Brian Hutton, Lisa Vandermeer, Sasha Mazzarello, Dean Fergusson & Mark Clemons

  3. Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada

    Nathalie Levasseur, John Hilton & Mark Clemons

  4. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada

    Brian Hutton, Dean Fergusson & Mathew McInnes

  5. Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada

    Anil A. Joy

  6. Department of Nursing, Ottawa Hospital, Ottawa, ON, Canada

    Sheryl McDiarmid

  7. Department of Radiology, The Ottawa Hospital Research Institute Clinical Epidemiology Program, The University of Ottawa, Ottawa, Canada

    Mathew McInnes

  8. The Ottawa Hospital, Ottawa, Canada

    Risa Shorr

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  1. Andrew Robinson
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Corresponding author

Correspondence to Mark Clemons.

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Conflict of interest

BH consults for Cornerstore Research. All other authors have nothing to disclose.

Ethical approval

Ethics approval was not required for this systematic review.

Informed consent

Informed consent was not required for this systematic review.

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Robinson, A., Souied, O., Bota, A.B. et al. Optimal vascular access strategies for patients receiving chemotherapy for early-stage breast cancer: a systematic review. Breast Cancer Res Treat 171, 607–620 (2018). https://doi.org/10.1007/s10549-018-4868-x

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