Objective: To establish whether using alternating arms for peripheral intravenous epirubicin administration affects the severity or duration of epirubicin-induced phlebitis.Methods: An observational study of women with breast cancer (n = 237) in a UK Cancer Centre. Data were analysed after receiving three treatment cycles according to the arm used for epirubicin administration: same, alternating or mixed arm (two consecutive cycles in one arm and one in the alternate arm). Phlebitis severity was graded by clinical staff after each treatment; participants also self-reported symptoms during treatment and for up to 6 months after.
Results:The alternating arm group experienced significantly less severe symptoms than the other arm use groups, 6% (4 of 64) compared with 34% (p < 0.001, odds ratio: 0.13 (95% CI: 0.043-0.38) alternating arm compared with same arm group). The alternating arm group reported less pain (p = 0.013), lower overall impact (p = 0.009), lower effect on function (p = 0.032) and shorter duration of symptoms (p = 0.001) than the other arm use groups.Conclusion: Using alternating arms for peripheral administration of epirubicin significantly reduces the severity and duration of chemical phlebitis and is recommended to improve patient experience and reduce the need for central venous access devices.
K E Y W O R D Sbreast cancer, chemical phlebitis, chemotherapy, epirubicin, peripheral venous cannulation, phlebitis severity
(OS). Secondary outcomes were overall mortality and loss of follow-up rates. Data were analyzed using SPSS 21, with p<0.05 being considered statistically significant. Results Three hundred and forty (340) cases of gynecological cancers were diagnosed during the study period, respectively 46 in 2016, 94 in 2017 and 200 in 2018 (p<0.001). The mean age was 54.3 years [range 19-90], ranging from 58.8 years in 2016 to 54.2 years in 2018 (p=0.013). Cervical cancer was the most common type (n=238,70%), followed by endometrial cancer (n=45, 13.2%), ovarian cancer (n=43, 12.6%), vulvar cancer (n=3, 0.9%), vaginal cancer (n=2, 0.6%) and gestational trophoblastic cancer (n=2, 0.6%). Seven (2.1%) cases were cancers of unknown primary identified as gynecological cancers. Of the staged patients (n=285), 66% were at stages III or IV of their cancer. The overall mortality rate was 34.7%, with a median overall survival of 3.9 months. Twenty-six (7.6%) of the patients lost follow-up. Conclusions Gynecological cancers were mostly diagnosed at an advanced stage, which mainly explains the low OS. Vaccination and large-scale screening are mandatory to decrease the burden of cervical cancer in Haiti.
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