ABSTRACT
Purpose: Although totally implantable venous access ports (TIVAPs) have been safe and valuable in the management of cancer and other chronically ill patients who require long-term intermittent venous access, a few complications have been reported with their use. Data on the use of TIVAPs in sub-Saharan Africa and other low- and middle-income regions is limited. In this study, we determine the complications that arise from TIVAP use at a cancer centre in Nigeria. Patients and Methods: Between 4 January 2018 and 15 September 2020, 100 patients received TIVAPs at our centre, primarily for the administration of chemotherapy for the treatment of solid tumours. Data were retrospectively extracted from the institutional electronic medical records and descriptive analysis of patient and disease characteristics, port-specific data and data on complications and outcomes was conducted. Results: The 100 patients who were implanted with TIVAPs at our cancer centre had their devices in situ for a total of 27,183 days, with a mean duration of use of 272 catheter-days (SD: 267 days; range: 2-952). TIVAP-related complications were identified in 13 patients (13%), i.e., an incidence of 0.478 complications/1,000 catheter-days. The mean time to onset of complications was 61 days (SD: 105 days; median: 23 days; range: 0-389). The complications observed include port-site bleeding, pocket infection, cutaneous site infection, arterial puncture, wound dehiscence, difficult access (due to port malpositioning and port site fibrosis) and others. No deaths, pneumothorax, haemothorax, catheter occlusions, or catheter-associated venous thromboses were recorded. Conclusion: Our study shows that TIVAPs can be used successfully in our environment and presents a case for more widespread use to improve both the patient experience and the ability of healthcare providers to deliver optimal treatment.
ABSTRACT
PURPOSE: Comorbidities have been indicated to influence cancer care and outcome, with strong associations between the presence of comorbidities and patient survival. The objective of this study is to determine the magnitude and pattern of comorbidities in Nigerian cancer populations, and demonstrate the use of comorbidity indices in predicting mortality/survival rates of cancer patients. METHODS: Using a retrospective study design, data were extracted from hospital reports of patients presenting for oncology care between January 2015 and December 2016 at two tertiary health facilities in Lagos, Nigeria. Patient comorbidities were ranked and weighted using the Charlson comorbidity index (CCI). RESULTS: The mean age for the 848 cancer patients identified was 53.9 ± 13.6 years, with 657 (77.5%) females and 191 (22.5%) males. Breast (50.1%), cervical (11.1%) and colorectal (6.3%) cancers occurred most frequently. Comorbidities were present in 228 (26.9%) patients, with the most common being hypertension (20.4%), diabetes (6.7%) and peptic ulcer disease (2.1%). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%) and ≥7 (0.6%). The mean CCI scores of patients ≤50 years (0.8 ± 0.9) and ≥51 years (3.3 ± 1.2) were significantly different (p < 0.05). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 versus 2.5 ± 1.9; p < 0.05) and/or surgery (2.1 ± 1.5 versus 2.4 ± 1.7; p < 0.05). CONCLUSION: Comorbidities occur significantly in Nigerian cancer patients and influence the prognosis, treatment outcome and survival rates of these patients. There is a need to routinely evaluate cancer patients for comorbidities with the aim of instituting appropriate multidisciplinary management measures where necessary.
