Supportive care challenges in a resource limited oncology setting: prevalence and management of anthracycline and vinca alkaloid extravasation in Sudan

Chemotherapy extravasation is a serious complication of cancer treatment, particularly with vesicant agents such as anthracyclines and vinca alkaloids. Data from low-resource settings, particularly in Sudan remain limited. Therefore, this study aimed to determine the prevalence, clinical characteristics, associated factors, and management practices of anthracycline and vinca alkaloid extravasation. A prospective cohort study was conducted from March to April 2023 including cancer patients receiving anthracyclines and/or vinca alkaloids at Khartoum Oncology Hospital, Sudan. Clinical and demographic data were collected using a structured form. Extravasation was assessed and graded using CTCAE v4.0. Data were analyzed using descriptive statistics and chi-square testing. Among 264 patients, 193 (73.1%) were female and 92 (34.8%) were aged 46–60 years. Breast cancer was the most common diagnosis 145 (54.9%). The prevalence of extravasation was 22 (8.3%); all cases occurred in patients who received chemotherapy via peripheral intravenous access. Most events occurred during previous cycles 14 (63.6%) and at first dose administration 11 (50.0%). The most frequent symptoms were phlebitis 17 (77.3%) and pain 13 (59.1%), with severe tissue injury in 5 patients (22.7%). Grade 2 extravasation was most common 17 (77.3%). No patients received pharmacological antidotes or supportive measures beyond stopping chemotherapy in 3 cases (14%). No significant associations were observed between extravasation and demographic or clinical variables (p > 0.05). This study revealed a high prevalence of extravasation among patients receiving anthracyclines and vinca alkaloids, along with major deficiencies in management practices. The implementation of standardized protocols, staff training, and access to antidotes is urgently needed to improve patient safety in resource-limited oncology settings.