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

• Published in: Journal of clinical oncology Vol. 32; no. 22; pp. 2351 - 2356
• Main Authors: LIPITZ-SNYDERMAN, Allison, SEPKOWITZ, Kent A, ELKIN, Elena B, PINHEIRO, Laura C, SIMA, Camelia S, SON, Crystal H, ATORIA, Coral L, BACH, Peter B
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01.08.2014
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Catheter-Related Infections - epidemiology; Central Venous Catheters - microbiology; Cohort Studies; Female; Humans; Male; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - drug therapy; Neoplasms - epidemiology; Neoplasms - microbiology; ORIGINAL REPORTS; Proportional Hazards Models; Retrospective Studies; Risk Factors; SEER Program; Tumors; United States - epidemiology; United States; Human; Intravenous administration; Use; Risk; Malignant tumor; Long term; Central vein; Infection; Cancerology; Risk factor; Adult; Elderly; Age; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2013.53.3018

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. 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. 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. 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.