Deciding Between Two Therapies for Dyspnea in Malignant Pleural Effusions
Draining and pleurodesis versus indwelling pleural catheters: Outcomes were generally equivalent.
Malignant pleural effusions can cause disabling dyspnea and chest pain. Traditional treatment has been drainage and pleurodesis; however, use of small indwelling pleural catheters has increased recently. It is unclear which procedure produces better symptom relief.
In this multicenter U.K. trial, 106 patients with malignant pleural effusions were randomized to talc pleurodesis or catheter placement. During the first 42 days, patients in both groups had similar significant improvements in dyspnea. At 6 months, the catheter group had significantly better dyspnea scores (a 14-mm difference on a 100-mm visual analog scale), but it is noteworthy that only 54 patients were included in this analysis, as nearly half the patients had died. Patients in both groups had similar slight improvements in chest pain and similar quality-of-life scores. Complications, mainly infections or catheter blockage, were more common in the catheter group (40% vs. 13%). At 1 year, pleurodesis patients had spent a median of 4.5 days in the hospital versus 1 day for catheter recipients.
Comment: No clear winner emerged from this study –– both procedures effectively improved dyspnea. Choice of treatment for malignant pleural effusion should be guided by patient preference. If being at home is a priority for a patient, a pleural catheter is probably a better choice, although the higher risk for subsequent infection or blockage should be mentioned during counseling.
Published in Journal Watch General Medicine June 28, 2012
