Complications associated with use of long-term central venous catheters among commercially insured women with breast cancer Journal Article
| Authors: | Lipitz Snyderman, A.; Ma, Q.; Pollack, M. F.; Barron, J.; Elkin, E. B.; Bach, P. B.; Malin, J. L. |
| Article Title: | Complications associated with use of long-term central venous catheters among commercially insured women with breast cancer |
| Abstract: | Purpose: Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications. Methods: Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and casemix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular com-plications between patients using long-term CVCs and those using temporary intravenous catheters. Results: Approximately two thirds of the cohort had a longterm CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovas-cular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters. Conclusion: Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider-or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs. © 2015 by American Society of Clinical Oncology. |
| Keywords: | adult; cancer chemotherapy; controlled study; aged; major clinical study; cancer patient; breast cancer; health insurance; cardiovascular disease; long term care; bloodstream infection; trastuzumab; infection risk; central venous catheter; intravenous catheter; human; female; article; thrombovascular complication |
| Journal Title: | Journal of Oncology Practice |
| Volume: | 11 |
| Issue: | 6 |
| ISSN: | 1554-7477 |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2015-11-01 |
| Start Page: | 505 |
| End Page: | 510 |
| Language: | English |
| DOI: | 10.1200/jop.2015.004796 |
| PROVIDER: | scopus |
| PMCID: | PMC4647067 |
| PUBMED: | 26265170 |
| DOI/URL: | |
| Notes: | Export Date: 2 December 2015 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work