Provider Differences in Use of Implanted Ports in Older Adults With Cancer

Abstract

Background Identifying unwarranted variation in healthcare can highlight opportunities to reduce harm. One often discretionary process in oncology is use of implanted ports to administer intravenous chemotherapy. While there are benefits, ports carry risks. This study’s objective was to assess provider-driven variation in port use among cancer patients receiving chemotherapy. Research Design Retrospective assessment using population-based SEER-Medicare data to assess differences in port use across healthcare providers of older adults with cancer. Participants included over 18,000 patients ages 66 and older diagnosed with breast, colorectal, lung, or pancreatic cancer in 2005-2007, treated by approximately 2,900 providers. We identified port use for patients receiving treatment from hospital outpatient facilities versus physicians’ offices. Our main analysis assessed the likelihood of a patient receiving a port given port use by the provider’s last patient. For a sub-set of high-use providers, we examined individual provider-level variation by estimating the risk-adjusted likelihood of insertion. Results Patients receiving chemotherapy in hospital outpatient facilities were significantly less likely to receive a port than those treated in physicians’ offices, with adjusted odds ratios (AOR) varying from 0.50 to 0.75 across cancer sites. Implanting a port was associated with increased likelihood of port insertion in the provider’s next patient (AOR varied from 1.71 to 2.25). Significant between-provider variation was found among providers with at least 10 patients. Conclusions Our findings support the idea that there is provider-driven variation in the use of ports for chemotherapy administration. This variation highlights an opportunity to standardize practice and reduce unnecessary use.

Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

“…Our analysis provides evidence of physicians’ consistent behavior with regard to overused services in oncology. We observed similar findings in our prior study 37 examining another example of a likely overused therapeutic service, implanted infusion ports in patients receiving chemotherapy. Our results are also consistent with evidence of patterns of hospice referral.…”

Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters

“…Of the 988 patients with breast cancer seen in our institution during the 6-year study period, the number of patients who had a port placed for administration of chemotherapy was 297 (30%), which represents the total study population and is not significantly different from other institutions. 2 We looked at a total of 147 patients with arm ports and 150 patients with chest ports. Among those who had chest ports, 82 (54.7%) were left sided and 68 (45.3%) were right sided.…”

“…Despite multiple attempts to deliver chemotherapy through peripheral intravenous catheters, up to 44% of patients with breast cancer over the age of 66 years receive a port to administer their chemotherapy, and patients who are younger or those who need an extended course of treatment are even more likely to undergo port placement. 2 Historically, chemotherapy ports have been implanted into the chest wall via the subclavian or internal jugular (IJ) veins, but upper-extremity access has become a popular choice in recent years. Various arguments in support of upper-extremity port placement include that arm ports are more cosmetically appealing, allow easier access, and may be medically indicated in certain patient populations.…”

Pembrolizumab microgravity crystallization experimentation

“…The scheduling and implantation of the port often delays mAb therapy and increases the risk of infection. 11 For this reason, there is ongoing research into the development of highly concentrated mAb formulations for SC injection, 12 administered at a local doctor’s office requiring less frequent dosing. A typical therapeutic dose can be in the 150–200 mg range.…”