Barriers to continuity of outpatient infusion-port maintenance among patients with cancer: a single-center cross-sectional study in China

Background Totally implantable venous access ports require timely outpatient maintenance to preserve long-term device safety; however, missed or delayed visits may reflect financial, health system, behavioral, psychosocial, and knowledge-related barriers. This study assessed the prevalence, determinants, and patient-reported consequences of discontinuous outpatient infusion-port maintenance among cancer patients in China. Methods This hospital-based observational analytical questionnaire study included adult patients with cancer who had an indwelling infusion port or comparable long-term venous access device. Discontinuous maintenance was defined as at least one missed or delayed scheduled maintenance visit during the preceding 6 months. Five prespecified barrier domain scores were evaluated: knowledge deficit, health system barriers, financial barriers, behavioral barriers, and psychosocial barriers. Modified Poisson regression with robust standard errors was used to estimate the prevalence ratios for discontinuous maintenance, and ordinal logistic regression was used to assess the severity of missed visits, satisfaction, and future maintenance intention. Results A total of 2,710 patients were included, of whom 1,076 (39.7%) reported discontinuous maintenance. Financial burden was the most common reason for the most recent missed or delayed visit (32.9%), followed by transportation difficulties (20.1%), fear or anxiety (18.9%), and lack of knowledge about maintenance timing (12.1%). In fully adjusted models, discontinuity was independently associated with financial barriers (adjusted prevalence ratio [aPR], 1.59; 95% CI, 1.47–1.72), knowledge deficit (aPR, 1.57; 95% CI, 1.44–1.72), health-system barriers (aPR, 1.40; 95% CI, 1.28–1.53), psychosocial barriers (aPR, 1.33; 95% CI, 1.22–1.44), and behavioral barriers (aPR, 1.30; 95% CI, 1.20–1.41). Discontinuity increased across the total barrier score quartiles from 13.0 to 68.9% ( p for trend < 0.001), indicating a strong cumulative barrier burden gradient. Adding barrier domains improved model discrimination from an AUC of 0.646 to 0.776. Discontinuous maintenance was also associated with more unscheduled port-related visits (22.7% vs. 5.5%; p < 0.001), lower satisfaction, and weaker future attendance intention. Conclusion Discontinuous infusion-port maintenance was common and independently associated with multiple modifiable barriers, supporting integrated interventions that combine patient education, appointment coordination, financial navigation, transport support, and reminder systems.