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Friday, July 25, 2014

Long-Term Central Venous Catheter Use and Risk of Infection in Older Adults With Cancer

+ Author Affiliations
  1. All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
  1. Corresponding author: Allison Lipitz-Snyderman, PhD, Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 300 East 66th St, 14th Floor, New York, NY 10065; e-mail: snyderma@mskcc.org

Abstract© 2014 by American Society of Clinical Oncology

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.

Footnotes

  • Supported by Cancer Center Support Grant No. P30 CA 008748.
  • Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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