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