title: Morbidity of chemotherapy administration and satisfaction in breast cancer patients: a comparative study of totally implantable venous access device (TIVAD) versus peripheral venous access usage.
abstract: BACKGROUND
  This prospective, non-randomized, comparative study evaluated morbidity of chemotherapy administration via a totally implantable venous access device (TIVAD) versus peripheral intravenous access (PIVA), and satisfaction in breast cancer patients in a limited-resource setting.
  
  
  METHODS
  Consecutive patients receiving chemotherapy via TIVAD (n = 114) or PIVA (n = 159) were studied. Venous access-related events were recorded. Morbidity and satisfaction with TIVAD or PIVA as perceived by the patients were assessed using a specifically designed questionnaire, which patients filled after 1st cycle of, and after completion of all chemotherapy.
  
  
  RESULTS
  Patients in the two groups were of comparable age, body mass index, and disease stage. Acceptance of TIVAD was higher in literate patients. TIVAD did not interfere with sleep or activities in 90 % of patients. The majority (81.2 %) were satisfied with the cosmetic outcome, 91.5 % would have TIVAD re-inserted if the need arose, and 89.6 % would recommend it to others. Non-fatal complications occurred in 16 patients, and TIVAD had to be removed prematurely in five patients. In the PIVA group, 40 % needed multiple needle pricks and 55.8 % developed thrombophlebitis or staining of arms. Drug extravasation and ulceration were suffered by 8.3 and 4.2 %, respectively. However, 78.3 % of patients reported no interference with daily activities and only 26 % would prefer a TIVAD. Those receiving more than six chemotherapy cycles were dissatisfied to a greater extent with PIVA (p < 0.05).
  
  
  CONCLUSIONS
  Breast cancer chemotherapy via TIVAD is safe and convenient and results in high satisfaction levels, although it involves additional expenditure. Chemotherapy via PIVA is acceptable, albeit with lower satisfaction, more so in those receiving more than six chemotherapy cycles.
authors.affiliation: Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
authors.forename: Kul Ranjan
authors.initials: KR
authors.lastname: Singh
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.forename: Gitika
authors.initials: G
authors.lastname: Nanda
authors.forename: Gyan
authors.initials: G
authors.lastname: Chand
authors.forename: Anjali
authors.initials: A
authors.lastname: Mishra
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Verma
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Mishra
authors.forename: Puneet
authors.initials: P
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D017060:Patient Satisfaction; D011446:Prospective Studies; D062666:Vascular Access Devices
chemical_list: D000970:Antineoplastic Agents