Complications associated with central venous access devices in patients with early breast cancer

Abstract Introduction Survival rates are continuously improving for patients with early breast cancer. Oncological treatment is often necessary, either as neoadjuvant (NACT), adjuvant (ACT) or both. These treatments require a central venous access device (CVAD) for administration. Selection of the optimal CVAD type is debated, owing to variations in associated complications and their potential impact on treatment delivery or continuity. Method This retrospective, two-centre study compared complication rates between totally implantable venous access devices (TIVADs), used in Halland, and peripherally inserted central catheters (PICC-lines), used at Kristianstad Hospital, in women receiving (N)ACT for early breast cancer (June 2019-June 2022). Complications were graded using CTCAE v5.0. Statistical comparisons used Chi-square, Fisher's exact test, or Mann-Whitney U test as appropriate. Result A total of 499 patients were included (TIVAD n=257, PICC-line n=242). The two groups differed at baseline regarding BMI (PICC higher, p<0.001) and timing of chemotherapy (PICC more NACT-only, p=0.036). PICC-lines were associated with a significantly higher overall complication rate (20.7% [50/242] vs 10.1% [26/257]; OR 2.31 (95% CI 1.39-3.86; p<0.001)). Infection and thrombosis were the most frequent complications in both groups. No significant difference was found in complications affecting oncological treatment delivery (p=0.588) or in CTCAE complication grade (p=0.450). Discussion A fifth of all PICC-line patients experienced a complication related to the device, twice the frequency compared to patients with TIVADs. However, the device types did not differ in this cohort regarding oncological treatment delay or severity of complications, suggesting that both types of CVADs can be recommended for these patients.