Date of Award

2022

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine whether or not “Is the use of a PORT as opposed to a PICC more effective in improving quality of life in patients receiving chemotherapy?”

Study Design: Review of three randomized control trials (RCTs) including one monocentric RCT, one two-centre RCT, and one multi-centered RCT.

Data Sources: All articles were published in English and taken from peer-reviewed journals using PubMed. All articles were published between 2014-2020 and chosen based on their relevance to the clinical question.

Outcome Measured: The outcome measured was quality of life (QoL). The studies used patient-reported homemade questionnaires and/or a validated QLQ-C30 questionnaire. For consistency assessments provided at a 6-month interval from insertion were utilized.

Results: In the RCT led by Taxbro, et al.1 indicated no significant difference in QoL overall, but a significant difference in QoL for certain activities encompassing global health. A significant difference was noted in taking a bath (p=0.004) and working out (p=0.052). No significant difference was noted with discomfort (p=0.616), showering (p=0.382), arm movement (p=1.000), or getting dressed (p=1.000). Patel, et al.4 examined patient-rated questionnaires that were used to generally assess QoL. Although specific data was not provided, results stated: “no significant differences were noted between the groups in the quality-of-life measures examined.” Patel et al. did note a significant difference in median dwell time for PORTs compared to PICCs (p=0.0057) which may have impacted results if it were included in the questionnaire.4 In the RCT performed by Clatot, et al., the validated questionnaire used indicated patients with PORTs did not indicate improved QoL compared to patients receiving PICCs (p=0.48). The mean difference between PICCs and PORTs was 3.4 (p=0.48).8 The study also contained a homemade questionnaire assessing global satisfaction as QoL. Results were reported as mean scores. Comparison of the PICC and PORT groups indicated no significant differences (p=0.78).

Conclusion: One of the studies demonstrated that patients with PICCs reported a significantly worse QoL. Two studies indicated QoL did not differ significantly between patients receiving chemotherapy via a PICC or a PORT.

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