Use of Chemoports in a Comprehensive Cancer Care Center, a Retrospective Study

Aim of the Study: Treatment protocols that use intravenous cytotoxic agents need long term access to large veins, that can be maintained for a prolonged period in a sterile way. Use of implantable devices for this purpose have become the preferred choice these days, but they have their own set of problem s, starting from difficulties in cannulation to safely maintaining the access for a prolonged period of time in a sterile way. Moreover, the patient population undergoing these treatments are mostly immunosuppressed and prone to systemic infections making the care of any implanted device more difficult. The present study evaluates the experience of using chemoports in a comprehensive cancer care center.

Subjects and Methods: We retrospectively reviewed our experience in handling Chemoports inserted at our own hospital over a period of three years, as regards to difficulties during insertion and during administration of venotoxic agents. All patients who were advised more than 4 cycles of cytotoxic drugs were included and approval of the university research and ethics committee was taken prior to data analysis.

Results: Retrospective data of a total of 120 chemoports was evaluated for the study. The most common malignancy was breast cancer, and the commonest chemotherapeutic regimen was Adriamycin/Epirubicin and Cyclophosphamide followed by Taxanes. The preferred site of insertion was right subclavian vein in 52.5% of cases. The average time taken for the procedure ranged from 25 mins to 2 hrs. Procedural difficulties were documented in 48 [40%] insertions, the most common being multiple punctures for venous access. 3 patients developed hematoma during the procedure and, one patient had puncture of carotid artery. Passage of the catheter to the opposite jugular vein was an interesting happening and occurred in 3 patients. None of the patients who had subclavian vessel cannulation had pneumothorax. All the complications were managed conservatively. The median days of catheter life was 265 days. In the follow up period 30 patients [25%] had events related to difficulty of use and port related infection,12 patients had difficulties in canulation of the Chemo port reservoir and 6 Ports could not be used for further chemotherapy and were removed. Infectious complications were seen in 12 ports, the commonest being pocket site infection.

We had a policy of recommending removal of the chemoport 6 months after completion of the planned chemotherapy protocol or 2 years after placement of the port, whichever is earlier. At the end of the study period, 47 of the patients had their chemoports removed, 10 patients were lost to follow up and hopefully got the devices removed elsewhere.

Conclusion: The present day chemoports are simple to insert, and easy to manage with proper asepsis expected in an immunosupressed patient. However, a dedicated team of trained personnel viz. surgeons, anaesthesiologists, clinical oncologists and nursing staff, are necessary so that complications related to these devices are kept to a minimum. This is also important in resource poor countries where these costly devices are difficult to prescribe, so that once inserted, they can last till the end of chemotherapy.