Abstract
Background:
Extended maintenance intervals up to 12 weeks for totally implanted venous access ports (TIVAPs) appear safe in oncology patients after chemotherapy, but the safety of 24-week flushing schedules is unknown. We evaluated a 24-week maintenance protocol implemented during the COVID-19 pandemic in cancer survivors with indwelling ports.
Materials and methods:
We performed a single-center retrospective cohort study including adults (⩾18 years) with solid tumors who had completed intravenous anticancer therapy and were transitioned to a 24-week flushing protocol (January 2020-December 2024). Patients with ongoing port use or shorter/irregular intervals were excluded. The primary endpoint was any port-related complication (occlusion, infection, thrombosis, mechanical failure, or other) during the maintenance phase. Incidence rates per 100 port-years, Kaplan-Meier event-free survival and a univariable Cox model for Charlson comorbidity index were calculated.
Results:
Among 105 patients (70.5% female; median age 60 years), breast and colorectal cancers accounted for 76.2% of tumors and 81.9% had early-stage disease. Median Charlson index was 0 (IQR 0–1). Ports were followed for 257.4 port-years (median 950 days), with a median of 5 maintenance visits and median interval 25.1 weeks; 88% of flushes occurred within ±4 weeks of schedule. Six patients (5.7%) experienced a complication: two occlusions, two mechanical malfunctions, one catheter-related thrombosis, and one pain-related removal; no infections or port-related deaths occurred. Overall incidence was 2.33 events/100 port-years (95% CI 0.86–5.07). Event-free survival was 97.0% at 12 months and 95.7% at 24 and 36 months; median was not reached. Charlson index was not associated with complications (HR 0.96, 95% CI 0.68–1.34; p = 0.79).
Discussion:
In a low-comorbidity, post-therapy population managed with standardized insertion and nursing protocols, a 24-week flushing interval yielded very low complication rates, comparable to those reported for 4–12-week schedules. The analytic cohort consisted predominantly of long-term, low-comorbidity survivors with ports already in place for several years, which likely reduced baseline complication risk. This selection bias limits generalizability to higher-risk populations. Although no infections were observed across 257 port-years, the confidence intervals remain wide due to the small number of events; therefore, these findings should be interpreted as suggestive rather than definitive evidence of safety.
Conclusion:
A 24-week TIVAP maintenance interval after completion of intravenous therapy appeared feasible and safe in this real-world cohort, with no infections and excellent port survival. These findings support cautious consideration of ultra-extended intervals in selected cancer survivors but require confirmation in larger prospective comparative studies before broad implementation.
Categories:
Supportive oncology, vascular access, health services and survivorship care.
Keywords
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