Reducing the risk of anthracycline-induced phlebitis in breast cancer patients

Anthracycline chemotherapy including epirubicin is known to have the potential to cause phlebitis and venous sclerosis when administered via a peripheral cannula. Breast cancer patients are particularly at risk of chemical phlebitis as it has been widely accepted practice after breast surgery to only use the contralateral
arm for intravenous treatments. The breast cancer clinicians and intravenous access specialist nurse in consultation with the lymphoedema specialist nurse reviewed the evidence base for this practice, and a decision was made at Velindre Cancer Centre to recommend using alternate arms for chemotherapy dministration in patients who had not had an axillary node clearance.
The aim of the study was to establish if there is a difference in the severity of epirubicin-related phlebitis depending on whether treatment is administered all in one arm or alternate arms.
The study was a prospective observational study using primarily quantitative methods to collect staff and patient assessments of phlebitis symptoms following each cycle of epirubicin. The participant questionnaires were designed to allow participants to self-report the severity of symptoms and the impact on their everyday activities. The chemotherapy phlebitis assessment tool used for the clinical assessment of symptoms was a tool developed by Velindre Cancer Centre (currently awaiting publication). Data were collected from a total of 237 participants who received three cycles of epirubicin chemotherapy.
The data were analysed using SPSS and demonstrated that the severity of phlebitis was significantly lower in patients receiving chemotherapy in alternating arms when compared to those who had received all cycles in the same arm (p=0.004). Using alternating arms for epirubicin administration in breast cancer patients who have not had an axillary node clearance reduces the risk of severe phlebitis. If this practice is adopted it can reduce the need for PICC placement and significantly improve the patient’s experience.