The Effect of Education on Comfort and Anxiety Levels in Patients Receiving 5-FU Treatment Administered With an Elastomeric Pump: A Randomized Controlled Trial

Cancer is a chronic and fatal disease with an increasing global incidence. According to the 2022 Global Cancer Report prepared by the International Agency for Research on Cancer (IARC), a specialized agency of the World Health Organization, there were approximately 20 million new cancer cases and 10 million cancer-related deaths worldwide. Demographic projections estimate that the number of new cancer cases per year will rise to 35 million by 2050, representing a 77% increase compared to 2022 (International Agency for Research on Cancer [IARC]). Cancer is a progressive disease, and as it advances, patients may experience various physical and psychological symptoms. Many of these symptoms arise not from the disease itself but as side effects of chemotherapy (Temiz and Durna, 2020). Surgical interventions, radiotherapy, and chemotherapy are among the primary treatment methods for cancer. Although chemotherapy positively affects survival, it is also associated with severe physical and psychological side effects. Due to the long-term and repetitive nature of chemotherapy, ensuring safe intravenous administration of chemotherapeutic agents is crucial (Chefchaouni et al., 2023; Burucu and Polat, 2024).

A port catheter is a closed system consisting of a catheter that extends into the central vein, a subdermal reservoir connected to the catheter, and a specialized needle inserted from the dermis into the reservoir (Özden et al., 2012; Paleczny et al., 2013). Typically implanted over the upper pectoral muscle in the upper thoracic region (chest port), port catheters can also be placed in the upper arm or femoral (inguinal) region as alternatives (Paleczny et al., 2013; Pinelli et al., 2018). These subcutaneously implanted vascular access devices facilitate the infusion of chemotherapeutic agents, provide fluid support, and ensure long-term supportive care when needed. They allow for outpatient chemotherapy administration, enabling patients to return home on the same day, thereby increasing patient satisfaction (Burucu and Polat, 2024).

Given the extended duration of cancer treatment, port catheters are preferred over other central venous catheters. Their subcutaneous placement reduces the risk of complications such as occlusion, infection, dislocation, thrombosis, extravasation, phlebitis, and bleeding, and eliminates the need for dressing after wound healing (Odabas et al., 2014; Kesici et al., 2017; Pu Y-L et al., 2020). With specialized knowledge, attention, and experience, port catheters can be used safely for many years (Esfahani et al., 2015; Önder et al., 2014). While implantation is the responsibility of the clinician, needle insertion, catheter care, and initiating appropriate interventions in case of complications require a team effort in which nurses play a central role (Yeşil et al., 2014). Before port needle insertion, nurses inform patients and their families about the rationale for catheter insertion, the procedure, necessary precautions, possible complications, and symptoms. Patients sign an informed consent form. A detailed medical history is obtained, allergies are queried, and premedication is administered if necessary (Oran, 2009; Turan and Cantürk, 2013; Yeşilbalkan, 2005).

Needle access to the port may cause procedural pain and anxiety, reducing patient comfort. Healthcare professionals bear significant responsibility in minimizing these effects (Kutlu, 2015). Physicians and nurses must provide continuous education to patients and families to ensure optimal care (Yeşilbalkan, 2005). Accordingly, nurses' knowledge and experience regarding port catheter care are crucial. Nurses, as vital providers of healthcare, have critical responsibilities in safely performing interventions, preventing and detecting complications early, and educating patients and their families about catheter care (Öztaş et al., 2022). Studies show that informed patients experience less anxiety and fear, whereas uninformed patients are more affected by early-stage complications (Uslu et al., 2019).

5-Fluorouracil (5-FU) remains one of the most commonly used antineoplastic agents for advanced colorectal cancer. To exert its effect, 5-FU must be converted into a nucleotide. As an antimetabolite chemotherapy drug, 5-FU can be administered via intravenous infusion over 5-10 minutes, 20-60 minutes, or as continuous infusions over 22-24 hours for one to four days. Common side effects include bone marrow suppression, nausea, vomiting, anorexia, sore throat, hair loss, and diarrhea. Rare side effects include gait disturbances, eye irritation, confusion, severe allergic reactions, and cardiac complications such as acute coronary syndrome, cardiomyopathy, vasospastic angina, heart failure, arrhythmias, and sudden cardiac death. Cardiac effects usually subside after discontinuation of the infusion (Stewart et al., 2012; Shoemaker et al., 2004).