Peripheral IV Access for Chemo Better Than Central Lines in Testicular Cancer?

Patients with testicular cancer had fewer venous access-related complications and overall thrombotic events when first-line chemotherapy was delivered via peripheral intravenous access compared with central venous access devices (CVADs), a retrospective study suggested.

Among 154 patients, those in the CVAD group compared with the peripheral IV group experienced more venous access-related complications (52.2% vs 24.2%) and overall thrombotic events (35.9% vs 6.5%), reported Brett Wiesen, MD, of the University of Colorado in Aurora, and colleagues.

Of the 92 patients who had chemotherapy delivered through CVADs and the 62 who used peripheral IV access, a similar proportion of patients transitioned from one technique to the other, with 9.7% of patients transitioning from peripheral IV access to CVADs, and 10.9% of patients transitioning from CVADs to a different type of CVAD or peripheral IV access, they noted in JCO Oncology Practice.

“There were a variety of reasons for transitioning, including patient preference, but the fact that those patients starting therapy with peripheral IV did not transition more often because of purported intolerability is an important finding in this study,” the authors wrote.

Taken together, these findings are significant, “because it challenges a trend that all patients receiving chemotherapy should get CVAD for ease-of-use and reported low complication rates,” they added.

Wiesen and team also determined that factors associated with having complications with any type of venous access for chemotherapy included having higher-stage cancer, a higher number of cycles of chemotherapy, delayed therapy, and peripheral IV location (no patient who had an antecubital IV experienced complications).

“These data have implications for patient counseling regarding access choice, as well as for the choice of peripheral IV placement location,” they wrote.

In an editorial accompanying the study, Craig R. Nichols, MD, director of Testicular Cancer Commons in Portland, Oregon, and colleagues noted that “this was a retrospective observational study with all the limitations thereof, but provides reassuring evidence that adding complexity, new technology, multistep operations, time, money costs, and, often moderate and sometimes severe, patient burden do not automatically translate into corresponding patient value.”

Nichols and colleagues suggested that central venous catheter placement “adds risk without corresponding sufficient patient benefit and entirely in the guise of avoiding several additional peripheral IV starts every 3 weeks at the cost of potential myriad of complications of central catheter placement.”

The standard of care has always been peripheral IV access for delivery of bleomycin, etoposide, and cisplatin for germ cell testicular cancer, and should remain so “on the basis of simplicity, alacrity, broad availability, affordability, and low patient burden,” they added.

Thus, “utilization of CVADs should be rare in patients with testicular cancer,” they wrote.

This study included 154 patients with testicular cancer who underwent first-line systemic chemotherapy at the University of Colorado Hospitals from 2005 to 2020. Mean age was 33 years, 78.6% were white, 12.3% were Hispanic/Latino, and 6.5% were African American.

At the time of treatment, 26.3% of patients had stage I disease, 34.2% had stage II disease, and 39.5% had stage III disease. When stratified by International Germ Cell Cancer Consensus Group risk classification, 71.3% of patients were good risk, 14% were intermediate risk, 14.7% were poor risk, and the remainder unknown.

The mean number of chemotherapy cycles for this group was three.

The mean number of complications — defined as peripheral vein thrombus, peripheral vein extravasation, phlebitis, line-associated sepsis, local skin necrosis, pulmonary embolism, and line-associated deep vein thrombosis (DVT) — was greater with CVAD compared with peripheral IV access (1.12 vs 0.38), and there were more line-associated DVTs in the CVAD group (23.2% vs 1.6%).

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