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.

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.