Daily Drainage in Malignant Pleural Effusion Could Improve Quality of Life

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There were no significant differences between the daily drainage and symptom-guided drainage groups in terms of total hospitalized days, mortality, and pain.
There were no significant differences between the daily drainage and symptom-guided drainage groups in terms of total hospitalized days, mortality, and pain.

In individuals with malignant pleural effusion, daily indwelling pleural catheter drainage might boost spontaneous pleurodesis more effectively than drainage regimens guided by symptoms, according to a study published in The Lancet Respiratory Medicine. As a result, daily drainage could improve quality of life.

This open-label, randomized trial included 87 participants with symptomatic malignant pleural effusion; 43 were randomly assigned to aggressive (daily) drainage, and 44 were assigned to symptom-guided drainage. The 2 groups did not show significant differences in daily breathlessness scores (geometric mean 13.1 mm [95% CI, 9.8-17.4] for daily vs 17.3 mm [95% CI, 13.0-22.0] for symptom-guided; geometric means ratio 1.32 [95% CI, 0.88-1.97]; P =.18).

Spontaneous pleurodesis was achieved more frequently in the daily group (16/43 [37.2%]) than in the symptom-guided group (5/44 [11.4%]; P =.005) during the first 60 days. The same difference was observed at the 6-month mark (19/44 [44.2%]; vs 7/43 [15.9%]; P =.004; hazard ratio, 3.29; 95% CI, 1.40-7.74; P =.0065). 

The daily group also reported better quality of life than the symptom-guided group on the EuroQoL-5 Dimensions-5 Levels (estimated means 0.713 [95% CI, 0.647-0.779] vs 0.601 [95% CI, 0.536-0.667], with an estimated difference in means of 0.112 (95% CI, 0.019-0.204; P =.0174). There were no significant differences between groups in terms of total hospitalized days, mortality, and pain, and serious adverse events affected a similar number of patients in each group (11/43 [25.6%] in the daily group and 12/44 [27.3%] in the symptom-guided group). Pleural infection affected 5 participants in the aggressive group and 6 in the symptom-guided group.

The trial was conducted at 11 centers in New Zealand, Hong Kong, Australia, and Malaysia. Participants were minimized by mesothelioma vs other types of cancer, performance status via Eastern Cooperative Oncology Group score, previous pleurodesis, and current presence of trapped lung. Follow-up lasted 6 months, with the primary outcome being mean daily score for breathlessness in the first 60 days and secondary outcomes that included self-reported quality of life and rate of spontaneous pleurodesis.

"[N]o differences [were found] between the aggressive (daily) and the symptom-guided drainage regimens for indwelling pleural catheters in providing breathlessness control,” researchers concluded. “These data indicate that daily indwelling pleural catheter drainage is more effective in promoting spontaneous pleurodesis and might improve quality of life."

Reference

Muruganandan S, Azzopardi M, Fitzgerald DB, et al. Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial [published online July 20, 2018]. Lancet Respir Med. doi:10.1016/S2213-2600(18)30288-1

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