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Safety and efficacy of implanted central venous catheters during adjuvant treatment of breast cancer and in a general oncology population.

9124 Background: Increasingly, women are choosing to receive short courses of adjuvant chemotherapy via an implanted central venous catheter (CVC) due to the perceived risk of lymphoedema if peripheral access is used in the at-risk limb. Two serious complications of CVCs (right atrial thrombosis with haemodynamic collapse and a cerebral sinus thrombosis) caused us to question this and review the complication rates of CVCs during adjuvant chemotherapy for breast cancer, compared to all patients receiving therapy via CVCs.


METHODS
We reviewed the records of patients (pts) receiving chemotherapy at Auckland City Hospital via a CVC, who were identified from a prospective database of CVC insertions. Pt characteristics, treatment type, intra and post-operative complications were recorded.


RESULTS
Between 1 Jun 08 and 1 Dec 09, 376 pts had 385 CVCs inserted. 140 pts had 144 CVCs for adjuvant breast cancer therapy. Overall 89 pts developed 103 complications. 32 CVC related infections were recorded (8.3%), with bacteraemia in 14. 15 DVTs (3.9%) and 2 catheter occlusions from thrombus were identified 13-260 days post CVC insertion. CVC complications led to 50 hospital admissions in 38 (10.1%) pts with a median stay of 5 days (range 1-33). Median time to first complication was 43 days (range 0-430). 11 treatment delays resulted (median 7 days, range 7-90). 33 (8.6%) pts needed early CVC removal. Left sided CVCs had higher complication rates (OR 3.0 p<0.0001). No deaths occurred. Adjuvant breast cancer pts had 26 admissions (18 pts), 7 DVTs (4.9%), 16 CVC infections (11.1%) and 9 treatment delays (median 7 days, range 7-28). Dose intensity data will be presented at the meeting. Adjuvant breast cancer pts complication rates were higher compared with other adjuvant pts (OR 2.1 p<0.05) and all other pts (OR 1.8 p<0.02). No association was seen with chemotherapy regimen or BMI.


CONCLUSIONS
Contrary to expectation, the risks associated with CVCs appear to be greater in women receiving adjuvant therapy for breast cancer than in other pts. The risks of these devices may outweigh any impact of peripheral venous access on lymphoedema incidence, which is not as yet objectively quantified, particularly after SLNB.