[The role of central vascular access in the management of patients receiving chemotherapy for non-hematological malignant tumors: PICC line versus implantable Ports].

Abstract

Introduction: peripherally inserted central catheters (PICCs) and totally implantable ports (Ports) are used for chemotherapy administration. This study aimed to compare their morbidity, mortality, and complication rates.

Methods: a prospective, randomised, comparative single-centre study with 6 months of follow-up included adult patients with non-hematological malignancies eligible for chemotherapy (palliative, curative, or adjuvant intent). Primary endpoints were the frequency of adverse events (minor/major), impact on quality of life (EORTC QLQ-C30), and medico-economic cost.

Results: out of 206 randomised patients, 192 were analysed (Port: 102; PICC: 90). The overall complication rate was 12.5% (n=24). Major complications were significantly more frequent with PICCs (17.8%; 16/90) than with Ports (4.9%; 5/102), with a relative risk of 3.6 (95% CI 1.3-9.9; p=0.041). For chemotherapy lasting less than 6 months, the mean total cost was significantly higher for Ports (160,123.41 DA) than for PICCs (43,259.69 DA) (p<0.001). No significant difference was observed in overall quality of life, with a modest trend favoring Ports for global health and pain at three months.

Conclusion: Ports, although costlier, are associated with a significantly lower risk of major complications. They may be preferred as a safe and effective access for long-term chemotherapy. The optimal choice should integrate treatment duration, patient risk profile, and economic constraints.