Purpose: Central venous catheters (CVCs) have been demonstrated as a feasible method for chemotherapy delivery in colorectal cancer patients. The objective of our study was to explore the preference of colorectal cancer patients (89%) in our institution for port catheters (PCs) through comparing the costs and complications between peripherally inserted central venous catheters (PICCs) and PCs.
Methods: Overall, 777 colorectal cancer patients (89%) were eligible for central venous catheter (CVC) insertions from January 1, 2017, to January 1, 2019. We retrospectively compared the costs and complications following the introduction of PICCs and PCs in the infusion of intravenous chemotherapy agents in patients with colorectal cancer.
Results: A total of 773 colorectal patients were enrolled. The total cost of PICC and PC was US $436.20 and US $976, respectively. The complication rate was higher in the PICC compared with the PC group (45% versus 4%, P < 0.001). The late complication rate of the two groups was particularly pronounced (52% versus 7%, p < 0.001). The incidence rate of total complications, that were developed in patients, with and without hemostatic prophylaxis, was 0.7% versus 5.7% (p < 0.001).
Conclusion: Port devices are associated with higher costs but fewer complications, compared to PICC in patients with colorectal cancer.

Keywords: central venous catheter, CVC, colorectal cancer, port catheter, PC, peripherally inserted central venous catheter, PICC, complication, cost

INTRODUCTION

Central venous catheters (CVCs) have become mandatory for the delivery of therapies in cancer patients. Chemotherapy of colorectal cancer (CRC) has significantly advanced with the development of FOLFOX (5-FU, oxaliplatin and leucovorin), FOLFIRI (irinotecan,5-FU and leucovorin), and the combination of oral anticancer agents, such as capecitabine. In the last 2 years, chemotherapy that was used to treat 874 colorectal cancer patients, who were hospitalized in our department. To reduce risks during chemotherapy, central venous catheters (CVCs) have been replaced by port catheters (PC) and peripherally inserted central catheters (PICC), which are convenient routes for chemotherapy administration.¹ PICC usage shows the lowest procedure-related risk of severe adverse events (eg, hemothorax), because it can be inserted from the peripheral vein and without requiring surgical procedures. Moreover, it can be performed by trained nurses.^2,3 On the other hand, PC has the advantage of inexistence of a visible external line, with no risk of pulling and impairment of patients’ quality of life. However, both types of catheters have limitations, including the high cost of invasive insertion, port removal and weekly maintenance. A fixed type of CVC for routine use in patients’ colorectal cancer therapies cannot be recommended without adequate evidence. Costs could also serve as an important factor in decision making. This secondary analysis mainly focused on investigating the complication rates, that were recorded within the 6-month period following catheters’ insertion, and the incidence rates of early and late complications. These were divided into early (<30 days) and late (>30 days) complications starting from the day of the first implantation.⁴ This study is one of the few reports that compared the estimated additional costs and complications of applying PICC and PC in drugs delivery to colorectal cancer patients in China, and that explored whether the 89% of the patients that used these delivery systems made the right choice.

Central Venous Catheter Insertion in Colorectal Cancer Patients, PICC or PC?

Want to read more?

Want to read more?