Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study |
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| Authors: | R. Roberts A. Borley L. Hanna G. Dolan S. Ganesh E.M. Williams |
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| Affiliation: | 1. Velindre Cancer Centre, Whitchurch, Cardiff, UK;2. Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK;1. Hong Kong Integrated Oncology Centre, Hong Kong, China;2. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China;3. Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;4. Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China;5. Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong, China;1. University College London Cancer Institute, London, UK;2. Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK;3. Department of Medical Physics and Biomedical Engineering, University College London, London, UK;4. Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK;5. Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;7. Saudi Particle Therapy Centre, Riyadh, Saudi Arabia;1. University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada;2. University of Calgary, Department of Radiation Oncology, Calgary, Alberta, Canada;3. Sunnybrook Hospital, Toronto, Ontario, Canada;1. Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia;2. Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia;1. Division of Oncology, Department of Radiation Oncology, University of Calgary, Tom Baker Cancer Center, Calgary, Alberta, Canada;2. ICES, Toronto, Ontario, Canada;3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;4. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;5. Cancer Care Ontario, Toronto, Ontario, Canada;1. Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada;2. Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada;3. Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA |
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| Abstract: | AimsAnthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20–30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms.Materials and methodsA prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments.ResultsAfter three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001).ConclusionIt is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles. |
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| Keywords: | Anthracycline chemotherapy breast cancer epirubicin phlebitis risk factors |
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