Long-term central venous catheter use and risk of infection in older adults with cancer Journal Article

Authors: Lipitz Snyderman, A.; Sepkowitz, K. A.; Elkin, E. B.; Pinheiro, L. C.; Sima, C. S.; Son, C. H; Atoria, C. L.; Bach, P. B.
Article Title: Long-term central venous catheter use and risk of infection in older adults with cancer
Abstract: Purpose: Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. Patients and Methods: We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results: CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Conclusion: Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality. © 2014 by American Society of Clinical Oncology.
Keywords: controlled study; aged; major clinical study; cancer localization; cancer patient; pancreas cancer; colorectal cancer; breast cancer; lung cancer; retrospective study; nonhodgkin lymphoma; head and neck cancer; long term care; catheter infection; infection risk; central venous catheter; infection rate; central venous catheterization; very elderly; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 22
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-08-01
Start Page: 2351
End Page: 2356
Language: English
DOI: 10.1200/jco.2013.53.3018
PROVIDER: scopus
PMCID: PMC4105488
PUBMED: 24982458
Notes: Export Date: 2 September 2014 -- CODEN: JCOND -- Source: Scopus
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MSK Authors
  1. Camelia S Sima
    204 Sima
  2. Kent A Sepkowitz
    247 Sepkowitz
  3. Elena B Elkin
    151 Elkin
  4. Peter Bach
    202 Bach
  5. Crystal Son
    11 Son
  6. Coral Lynn Atoria
    49 Atoria