Extravasation with systemic anti-cancer directed therapy administration at daycare in a tertiary care oncology centre: Insights from a prospective observational study (EXACT study)

Background Establishing benchmarks for extravasation incidences with systemic anti-cancer therapy from various global regions is crucial. Reliable data can inform practices aimed at reducing both the occurrence and severity of extravasation events. Methods This prospective observational study evaluated extravasation incidences in patients receiving systemic anti-cancer therapy for solid tumors at a tertiary oncology daycare center over a period of 15 months. Multiple risk factors potentially contributing to extravasation and influencing its severity were systematically recorded and analyzed. Results Out of 66,540 infusions, a total of 58 extravasation cases were identified, resulting in an overall incidence of 0.087%. The extravasation incidence was 0.13% for vesicant drugs and 0.045% for irritant drugs. Specifically, DNA-binding vesicants had an incidence of 0.2%, while non-DNA binding vesicants had an incidence of 0.11%. The predominant symptom reported was infusion site swelling (86%), followed by pain (43%) and erythema (36%). Grade 3 extravasation occurred in 13 cases (22.4%), with vesicants responsible for all but one event. Median symptom resolution time was 20 days overall, extending to 40 days in grade 3 cases. Notably, the occurrence of symptoms either during infusion or within 6 h post-infusion significantly correlated with milder grade 1 extravasations, lower incidence of severe grade 3 cases, and quicker symptom resolution within three weeks. Conclusions Daycare oncology centers should implement standardized protocols for systemic therapy administration, emphasizing preventive strategies and prompt identification and management of extravasation to reduce associated morbidity.