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Fewer overall hospital days with use of indwelling pleural catheters vs pleurodesis for malignant effusions
Clinical Question
Does management of malignant pleural effusions with an indwelling pleural catheter as compared with talc pleurodesis reduce the number of days spent in the hospital from treatment to death?
Bottom line
Given an initial shorter hospitalization required for catheter placement and a decreased need for repeat pleural interventions, patients with malignant pleural effusions treated with indwelling pleural catheters (IPCs) as compared with those treated with talc pleurodesis spend 3 to 4 fewer days in the hospital from treatment to death. The clinical significance of this result will largely depend on patient preference but can guide shared decision-making. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
Reducing the number of days spent in the hospital can be an important benefit, especially for patients with advanced cancer. In this study, patients with confirmed malignant pleural effusions were randomized, using concealed allocation, to receive either IPCs or talc pleurodesis with the goal of minimizing time spent in the hospital from the time of procedure to death or to 12 months. One patient withdrew from each group, leaving 74 patients in the IPC group and 72 patients in the pleurodesis group for the final intention-to-treat analysis. An additional 3 patients in the IPC group and 9 patients in the pleurodesis group did not undergo their allocated treatment and were excluded from the per-protocol analysis. The 2 groups were similar at baseline: median age was 70.5 years and the most common underlying malignancies were lung cancer, mesothelioma, and breast cancer. The patients treated with IPC had fewer total days (as a group) spent in the hospital (median of 10 days vs 12 days; P = .03) and a mean reduction in hospitalization days per patient (13.4 days vs 16.3 days) than those treated with talc pleurodesis. Finding were consistent in the per-protocol analysis, with a mean reduction in hospitalization of 4.5 days per patient. Specifically, patients in the IPC group had a shorter stay for the initial hospitalization for catheter insertion and were less likely to require repeated pleural interventions after the initial procedure. No significant differences were noted in quality of life or survival but the IPC group did have slightly more minor adverse effects, primarily related to local infection.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
good poem
En sachant cette information cela me permettra de mieux aider les patients avec leur décision de traitement.
We have been trying to get more data to help increase community health nursing "support of" pleural catheters in the community. This data will help us with this initiative.
What about quality of life? How did the people treated with IPC feel they did compared to the other group?
It looks as if there was less hospital time, slightly more local issues but what about nursing time in the community, hardship on the family managing the IPC, overall patient satisfaction...?
I think I would like the IPC, but it depends upon the stage of the terminal cancer and how much functional status I had left in me...the IPC is no small affair.