Oncology · Medical Literature
[The role of central vascular access in the management of patients receiving chemotherapy for non-hematological malignant tumors: PICC line versus implantable Ports].
Abstract
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. 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. 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. 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.
Clinical relevance
In adult patients with non-hematological malignancies receiving chemotherapy, do totally implantable venous access ports (Ports) differ from peripherally inserted central catheters (PICCs) in complication rates, quality of life, and medico-economic cost over a 6-month follow-up period? __SNAPSHOT__ {"studyDesign":"Prospective, randomized, comparative single-centre trial","setting":"Single centre; country not explicitly stated in the abstract (authors affiliated with an Algerian institution based on journal and currency data — Algerian Dinar [DA] cited for costs)","sampleSize":"n=192 analysed (Port: n=102; PICC: n=90); 206 originally randomized (14 excluded post-randomization)","population":"Adult patients with non-hematological malignant tumors eligible for chemotherapy (palliative, curative, or adjuvant intent)","intervention":"Totally implantable venous access port (Port/chamber implantable)","comparator":"Peripherally inserted central catheter (PICC line)","primaryOutcome":"Frequency of adverse events (minor and major complications); quality of life assessed by EORTC QLQ-C30; medico-economic cost","followUp":"6 months","fundingSource":"Not reported"}
Key findings
Among 192 analysed patients (Port: 102; PICC: 90), the overall complication rate was 12.5% (n=24). Major complications were significantly more frequent in the PICC group (17.8%; 16/90) than in the Port group (4.9%; 5/102), yielding a relative risk (RR) of 3.6 (95% CI 1.3–9.9; p=0.041). The absolute risk difference for major complications was 12.9 percentage points (calculated), with a number needed to harm (NNH) of approximately 8 (calculated) — meaning approximately 8 patients would need to receive a PICC instead of a Port for one additional major complication to occur. For chemotherapy courses lasting fewer 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 currency conversion or USD equivalent was provided. No statistically significant difference in overall quality of life (EORTC QLQ-C30 global score) was observed between arms; a modest, non-significant trend favoring Ports was noted for global health and pain subscales at 3 months. Distribution of minor complications, specific complication types (e.g., thrombosis, infection, malposition), and mortality data are not reported in the abstract.
Practice implications
This RCT provides randomized, prospective evidence that Ports are associated with a substantially lower rate of major complications compared with PICCs in patients receiving chemotherapy for non-hematological solid tumors (RR 3.6; NNH ~8, calculated). This magnitude of effect is potentially clinically important, though the wide confidence interval (1.3–9.9) reflects meaningful statistical uncertainty and does not exclude a more modest true benefit. The cost advantage of PICCs for shorter treatment courses is statistically significant and economically substantial in the Algerian healthcare context; however, the absolute cost figures are reported in Algerian Dinars and direct translation to other health systems requires caution. Quality-of-life differences were not statistically significant, and the observed trends at 3 months should be interpreted as hypothesis-generating only. Important caveats: (1) only the abstract is available — key methodologic details such as randomization sequence, allocation concealment, blinding procedures, baseline characteristic balance, and specific complication definitions cannot be verified; (2) the study is single-centre, limiting generalizability; (3) the 14-patient post-randomization attrition (6.8%) may introduce selection bias if losses were differential between arms; (4) the population is restricted to non-hematological tumors, so findings do not apply to hematological malignancies; (5) chemotherapy-specific data (regimens, duration, cycle frequency) are not reported, making it difficult to identify which patient subgroups benefit most; (6) mortality outcomes are mentioned as an endpoint but no mortality data are presented in the abstract; (7) the economic comparison is context-specific and may not transfer to other health systems or cost structures. __LIMITATIONS__ 1. Single-centre design limits external generalizability. 2. Only the abstract is available; randomization quality, allocation concealment, and baseline comparability cannot be assessed. 3. Post-randomization exclusion of 14 patients (6.8%) without reported reasons introduces potential attrition bias. 4. Major complication rate in the PICC arm (17.8%) is higher than many published benchmarks, raising questions about insertion technique, catheter maintenance protocols, and definition of 'major' complication — none of which are detailed in the abstract. 5. Cost analysis is restricted to chemotherapy duration <6 months and expressed in Algerian Dinars, limiting economic transferability. 6. Quality-of-life assessment (EORTC QLQ-C30) was a co-primary endpoint, yet no statistically significant difference was demonstrated; the trial may have been underpowered to detect a meaningful QoL effect. 7. The confidence interval for RR (1.3–9.9) is wide, indicating imprecision in the complication estimate. 8. Specific complication subtypes (infectious, thrombotic, mechanical), minor complication rates by arm, and mortality data are not reported in the abstract. 9. Blinding of patients and clinicians is not feasible for device type and was not reported; this could influence reporting of subjective QoL outcomes. 10. Funding source is not reported, precluding assessment of sponsorship bias. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This single-centre RCT found that totally implantable Ports were associated with a significantly lower rate of major complications than PICCs in adult patients with non-hematological malignancies receiving chemotherapy (4.9% vs. 17.8%; RR 3.6, 95% CI 1.3–9.9), without a significant difference in quality of life. PICCs carried substantially lower costs for treatment courses under 6 months in this Algerian setting. Pending access to the full publication and replication in multi-centre settings, these findings support preferring Ports when major complication avoidance is the priority, while cost-effectiveness considerations may favor PICCs for short-duration chemotherapy regimens.