Tailored approach to the choice of long-term vascular access in breast cancer patients

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.

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PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy

The Journal of Vascular Access ◽

10.1177/1129729819884482 ◽

2019 ◽

Vol 21 (4) ◽

pp. 460-466 ◽

Cited By ~ 3

Author(s):

Sergio Bertoglio ◽

Ferdinando Cafiero ◽

Paolo Meszaros ◽

Emanuela Varaldo ◽

Eva Blondeaux ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Vascular Access ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Breast Cancer Patients ◽

Vascular Access Devices ◽

Access Device ◽

Vein Thrombosis ◽

Vascular Access Device

Background and objectives: The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. Methods: The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. Results: Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%–7.1%). With regard to the patients’ characteristics, body mass index <22.5 was the only significant risk for failure ( p = 0.027). Conclusion: The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.

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Diagnosis prevention and treatment for PICC-related upper extremity deep vein thrombosis in breast cancer patients

Asia-Pacific Journal of Clinical Oncology ◽

10.1111/j.1743-7563.2011.01508.x ◽

2012 ◽

Vol 8 (3) ◽

pp. e12-e16 ◽

Cited By ~ 8

Author(s):

Lei XING ◽

Vishnu Prasad ADHIKARI ◽

Hong LIU ◽

Ling Quan KONG ◽

Sheng Chun LIU ◽

...

Keyword(s):

Breast Cancer ◽

Deep Vein Thrombosis ◽

Cancer Patients ◽

Upper Extremity ◽

Breast Cancer Patients ◽

Vein Thrombosis ◽

Prevention And Treatment ◽

Deep Vein

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Mutational status and thromboembolic risk in lung, gastrointestinal and breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23147 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23147-e23147

Author(s):

Marco Platania ◽

Federico Nichetti ◽

Filippo G. De Braud

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Clinical Manifestations ◽

Gene Mutations ◽

Molecular Profile ◽

Breast Cancer Patients ◽

Vein Thrombosis ◽

Mutational Status ◽

Cancer Associated Thrombosis ◽

Low Prevalence

e23147 Background: Cancer-Associated Thrombosis (CAT) is one of the most threatening complications of cancer. Recent evidences suggested a link between the molecular profile of solid tumors and the incidence of CAT. The aim of this study was to explore the relationship between the mutational status of breast, lung and gastrointestinal cancer patients and the risk of CAT. Methods: We retrospectively evaluated the molecular profile, analysed as per clinical practice, of all consecutive patients hospitalized at the National Cancer Institute’s Department in Milan from October 2017 to November 2018. Patients with previous thromboembolic events and patients under anticoagulant therapy at cancer diagnosis were excluded. Due to death as competing risk, the Fine and Gray proportional regression model was used to detect statistical association and estimate relative risk. Results: The resulting cohort consisted of 484 patients, of whom 47% had gastrointestinal cancers, 18% had lung cancer and 15% had breast cancer. Molecular investigations were available for 375 (77%) patients; in particular, a 50-gene Next Generation Sequencing (NGS) panel was performed on 148 (31%) patients. After a median follow up of 17 months, 118 patients (24%) exhibited clinical manifestations of thrombosis (i.e. deep vein thrombosis, pulmonary thromboembolism, splanchnic thrombosis, disseminated intravascular coagulation, arterial thrombosis) and 117 (24%) patients deceased without thrombotic events. A statistically significant association was observed between incidence of CAT and presence of TP53 (HR 0.50, p = 0.04), c-KIT (HR 4.30, p = 0.041), and SMAD4 (HR 3.19, p = 0.029) mutations. No significant association was detected for KRAS and MET gene mutations, even if HRs were >2. Conclusions: In this study, the mutational status of TP53, SMAD4 and c-KIT genes was statistically associated to the risk of thrombosis. Due to methodological limits and low prevalence of mutations, large prospective studies are warranted, with the aim of better defining the role of oncogenes in CAT risk.

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Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement

Supportive Care in Cancer ◽

10.1007/s00520-016-3368-y ◽

2016 ◽

Vol 24 (12) ◽

pp. 5035-5040 ◽

Cited By ~ 1

Author(s):

Gabriel Liberale ◽

Michel El Houkayem ◽

Claire Viste ◽

Fikri Bouazza ◽

Michel Moreau ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Vascular Access ◽

Breast Cancer Patients ◽

Access Device ◽

Vascular Access Device

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Longitudinal follow-up of breast cancer patients with the tumor markers CA 549 and CA 15.3

The International Journal of Biological Markers ◽

10.1177/172460089501000106 ◽

1995 ◽

Vol 10 (1) ◽

pp. 30-34 ◽

Cited By ~ 2

Author(s):

L. Vankrieken ◽

F. Heureux ◽

J. Longueville ◽

R. De Hertogh

Keyword(s):

Breast Cancer ◽

Tumor Marker ◽

Cancer Patients ◽

Tumor Markers ◽

Clinical Situation ◽

Breast Cancer Patients ◽

Significant Information ◽

Ca 15.3 ◽

Cutoff Levels

In order to verify the efficiency of the tumor markers CA 15.3 and CA 549 in the follow-up of breast cancer patients, it was necessary first to check the cutoff levels of each tumor marker in women with an increased age-related risk, but with no evidence of disease. From 132 serum samples in this age group, we confirmed the CA 549 cutoff level of 12.1 U/ml. However, the cutoff of CA 15.3 was 34 U/ml, which is higher than previously reported in the literature. Fifty-two breast cancer patients with or without metastases at the time of entry into the study were followed for 2 to 3 years with both tumor markers. The sensitivity, specificity and the test efficiency for the presence of metastases were analyzed with each tumor marker. Taking into account the different cutoff levels, we concluded that both tumor markers can be used independently to follow the clinical situation of patients. In several cases an increase in both tumor markers was observed before a clinical diagnosis of metastases could be made. Combination of these two tumor markers gave no more significant information about the patient's clinical situation than each tumor marker alone.

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