Advantages of totally implanted port over impromptu short-term central venous catheter in oncological pain therapy

The aim of this paper is to determine if patient controlled analgesia (PCA) by means of programmable pumps improves patients' autonomy and to verify if the short-term central venous catheter - implanted when pain is first evident - makes the quality of life worse in comparison with an early implanted port. Forty non-terminally ill patients affected by urinary malignant pathologies with visceral and bone metastases were enrolled in a prospective and randomised study at the Urology Department of 'La Sapienza' University in Rome, Italy. Intensity of pain and tolerability of venous access were assessed for the first 7 days, and weekly for 3 months. Such data were used to adjust drug therapy. In this study we hypothesized that a delayed central venous catheter implant, when the pain is at first considerably evident, can interfere negatively with drug treatment. The visual analogue scale (VAS) and the brief pain inventory (BPI) were administered to the patients, and these showed good levels of analgesia in both groups and a greater comfort to the patients with the previously implanted port in comparison with a short-term central venous catheter. In conclusion, PCA achieves a constant level of drugs and enables the patient to voluntary control the pain by means of supplemental boluses. Both central devices seem to provide similar technical benefits, but the port is much more easily tolerated and the quality of life is increased if it is already available when pain is first evident.