Indwelling Pleural Catheter Reduces Hospitalisation For Malignant Pleural Effusion

Treating malignant pleural effusion with an indwelling catheter offers a small but significant reduction in the need for hospitalisation compared with talc pleurodesis

medwireNews: The AMPLE investigators have demonstrated a significant reduction in the duration of hospital stay required for patients with malignant pleural effusion who receive an indwelling pleural catheter compared with use of talc pleurodesis.

However, the difference in the primary endpoint of total all-cause hospital stay was just 2 days between the catheter and talc pleurodesis groups (10 vs 12 days), say YC Gary Lee, from the University of Western Australia in Perth, and co-investigators.

This outcome is of “uncertain clinical importance because there are no established minimal clinically important differences for this end point”, they write in JAMA

“This difference may be important to the hospital care system because it frees up substantial hospital beds and resources, but its relevance to clinical decision making for individual patients may depend on patient preference and circumstances”, they continue. 

The open-label, randomised trial was conducted at nine centres in Australia, New Zealand, Singapore and Hong Kong between 2012 and 2014. In all, 73 patients were followed-up for 12 months after receiving an indwelling pleural catheter and 71 patients after being treated with talc pleurodesis. 

Effusion-related hospitalization was required for a median of 1 day by the catheter-treated patients and 4 days by those given talc pleurodesis, while further requirement for ipsilateral invasive pleural drainage procedures was less common with catheter use, at 4% versus 22% of patients, respectively. Both these secondary endpoints reached statistical significance. 

“The lower reintervention rate with indwelling pleural catheter is an important consideration and benefit for patients with advanced cancer”, the authors comment. 

Nevertheless, breathlessness scores for both patient groups improved significantly within a day of the procedure to a similar extent and improvements were maintained over follow-up, the researchers report. There was no significant difference in quality of life between the treatment arms. 

Adverse events occurred in 30% of the catheter patients and 18% of the talc pleurodesis patients, most commonly increasing breathlessness and procedure-related pain. One catheter-treated patient with cardiac disease required resuscitation during implantation. Three patients treated with talc had serious adverse events, namely submassive pulmonary embolism, severe chest pain and a death during fracture surgery after a fall.

Reference

Thomas R, Fysh ETH, Smith NA, et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion. The AMPLE randomized clinical trial. JAMA 2017; 318: 1903-1912. doi:10.1001/jama.2017.17426

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