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

Robinson, Andrew C; Souied, Osama; Bota, Aura; LeVasseur, Nathalie; Stober, Carol; Hilton, John; Kamel, Dalia; Hutton, Brian; Vandermeer, Lisa; Mazzarello, Sasha; Joy, Anil A.; Fergusson, Dean; McDiarmid, Sheryl; McInnes, Matthew D. F.; Shorr, Risa; Clemons, Mark

doi:10.1007/s10549-018-4868-x

Cited by 45 publications

(45 citation statements)

References 26 publications

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“…1,4,5 With the development of PICCs, many studies have compared PICCs with other VADs for the purpose of selecting the most appropriate VAD in different clinical scenarios. [6][7][8] Most of the existing studies have focused on the complications related to catheters, the success rate of insertion, and catheter dwell days between PICCs and other VADs. [6][7][8] Several systematic reviews 6,8 indicated that PICCs were associated with more complications during maintenance compared with CVCs and PORTs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…[8][9][10][11][12] However, several systematic reviews have raised questions regarding the appropriateness of PICCs in patients with cancer due to the higher incidence of CR-DVT. [13][14][15][16]…”

Section: Long-term Central Venous Catheters Todaymentioning

confidence: 99%

“…A systematic review by Robinson et al regarding patients with breast cancer, was published in 2018. 15 This review identified three papers using questionnaires to examine quality-of-life in patients with breast cancer and a vascular access device. The authors concluded that the use of a PORT is generally well accepted.…”

Section: Patient Perceptionmentioning

confidence: 99%

Vascular access in cancer patients – clinical implications

Taxbro

2019

Linköping University Medical Dissertations

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“…Totally implanted venous access port (TIVAP) has been established as an effective and safe procedure for cancer patients, which could be applied to chemotherapy infusion, blood sampling, as well as nutrition supply [1,2]. TIVAPs have manifested evident superiority with fewer complications and more convenient catheter management compared with peripherally inserted central catheter or any other externally tunneled catheter [3]. In recent years, TIVAPs have been widely used in patients with malignancies needing to receive a long-term catheterization.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Arm Port and Chest Port for Optimal Vascular Access Port in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Liu

et al. 2020

BioMed Research International

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Objectives. This meta-analysis was conducted to compare the complication rates between arm and chest ports in patients with breast cancer. Design and Data Sources. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database were used to perform a systematic review and meta-analysis of publications published from the inception of the database to 11, October 2019. Our search generated a total of 22 articles published from 2011 to 2019, including 6 comparative studies and 16 single-arm articles, involving 4131 cases and 5272 controls. Single-arm studies combined with comparative studies were also pooled and analyzed. Finally, subgroup analysis was performed to compare the rates of infection and thrombosis between these two ports. Eligibility Criteria. Included articles were research studies comparing complication rates of arm ports with chest ports in patients with breast cancer. Any review or meta-analysis article would be removed. Data Extraction and Synthesis. Demographic data and information for the following analysis were extracted. DerSimonian and Laird random effect meta-analysis was conducted to analyze comparative studies while Begg’s and Egger’s tests were used for assessment of publication bias. Meta-regression analysis was performed to explain the sources of heterogeneity. Results. There was no difference in the risk of overall complications between arm and chest ports for comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (RR = 2.23, P=0.041) as well as pooled comparative and single-arm studies (RR = 1.21, P=0.029). Conclusions. This study indicated that the arm port might increase the risk of overall complication risks as well as the risk of catheter-related thrombosis compared with the chest port. However, these reported findings still need to be verified by large randomized clinical trials.

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

Abstract: 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.

Cited by 45 publications

References 26 publications

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

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

Vascular access in cancer patients – clinical implications

Comparison between Arm Port and Chest Port for Optimal Vascular Access Port in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

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