1
|
Alexander M, Ishisaka Y, Miyakawa L, Rothman A. Assessing Factors That May Impact Physician-based Decisions for Placing Indwelling Pleural Catheters. J Bronchology Interv Pulmonol 2024; 31:39-48. [PMID: 37185887 DOI: 10.1097/lbr.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Malignant pleural effusion is a common finding in patients with advanced cancer and is a frequent cause of dyspnea. Current guidelines indicate thoracentesis for symptomatic patients, while indwelling pleural catheters (IPC) are recommended for patients who develop pleural fluid re-accumulation. IPC maintenance, however, requires a significant level of financial and social support. This study aims to analyze potential influencing factors that may play a role in the decision for placing IPCs in patients with recurrent malignant pleural effusions. METHODS This study retrospectively collected baseline sociodemographic and laboratory data in patients who underwent thoracentesis for malignant pleural effusion from August 2016 to October 2021, and selected patients who presented with re-accumulation of pleural fluid within 30 days or had a pulmonary physician's note documenting that IPC is a potential management option. Of these selected patients (IPC candidates), we stratified patients who underwent IPC placement and those who did not, and performed statistical analysis between these 2 groups. RESULTS One hundred seventy-six patients who underwent thoracentesis were regarded as IPC candidates. Almost all baseline sociodemographic characteristics, including ethnicity ( P =0.637), sex ( P =0.655), and marital status ( P =0.773) were similar between the 2 groups, but significantly higher ECOG scores ( P =0.049) were noted in the IPC group. No statistically significant differences were noted in age, body mass index, platelet, PTT, international normalized ratio, creatinine, white blood cell, red blood cells, fluid protein, or fluid lactate dehydrogenase. Fluid albumin ( P =0.057) and serum neutrophil:lymphocyte ratio ( P =0.003) were significantly higher in patients without IPC placement. CONCLUSION This study did not recognize any baseline sociodemographic factors that may contribute to the decision to place IPCs.
Collapse
Affiliation(s)
| | | | - Lina Miyakawa
- Department of Pulmonary & Critical Care Medicine, Mount Sinai Beth Israel
| | - Adam Rothman
- Department of Pulmonary & Critical Care Medicine, Mount Sinai Morningside-West, New York, NY
| |
Collapse
|
2
|
Mishra EK, Stanton A. Patient-Reported Outcomes in Pleural Effusions: A Systematic Review. Cureus 2024; 16:e52430. [PMID: 38371010 PMCID: PMC10870697 DOI: 10.7759/cureus.52430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Pleural effusions cause breathlessness, decreased activity levels, and impaired quality of life. Clinical trials of drainage of pleural effusion use patient-reported outcome measures (PROMs) to assess these variables. This systematic review aimed to identify which PROMs have been used in clinical trials in pleural effusions, what variables were assessed, whether they were responsive to pleural interventions, and whether they have been validated in patients with pleural effusions, including a defined minimal clinically important difference (MCID). A systematic review was performed to identify relevant clinical trials from Medline, EMBASE, Emcare, and CINAHL and data were extracted. From 329 abstracts, 29 clinical trials of pleural effusion drainage that used PROMs as an outcome measure were identified. A total of 16 different PROMs were used. The most used PROMs were unidimensional measurements of breathlessness, particularly the visual analogue scale for dyspnoea (VASD), all of which nearly showed improvements in breathlessness following pleural fluid drainage. Other variables commonly assessed included activity levels and health-related quality of life. Multidimensional PROMs showed inconsistent responsiveness to pleural fluid drainage. Only the VASD was validated in this patient group with a defined MCID. A range of PROMs are used in clinical trials of pleural fluid drainage. No single PROM measures all the outcomes of interest. Unidimensional measurements of breathlessness are responsive to pleural fluid drainage. Only the VASD is validated with an MCID. There is a need for properly validated, response PROMs which measure the key outcomes of interest in this patient group.
Collapse
Affiliation(s)
- Eleanor K Mishra
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, GBR
| | - Andrew Stanton
- Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, GBR
| |
Collapse
|
3
|
Jones R, Steer H, Preston N, Perkins P. Malignant pleural effusions: the patient experience. BMJ Support Palliat Care 2023; 13:e254-e255. [PMID: 33707298 DOI: 10.1136/bmjspcare-2021-002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Jones
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Henry Steer
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Nancy Preston
- International Observatory of End of Life Care, Lancaster University, Lancaster, UK
| | - Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, Gloucestershire, UK
- Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| |
Collapse
|
4
|
Cloyes RR, Josan E, Pastis N, Ma J, Palettas M, Peng J, Vasko-Wood S, Mohrman C, Ghattas C, Presley C, Revelo A, Pannu J. Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study. BMJ Open Qual 2023; 12:e002197. [PMID: 37751941 PMCID: PMC10533796 DOI: 10.1136/bmjoq-2022-002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Malignant pleural effusions (MPE) can cause severe dyspnoea leading to greater than 125 000 hospitalisations per year and cost greater than US$5 billion per year in the USA. Timely insertion of tunnelled pleural catheters (TPCs) is associated with fewer inpatient days and emergency department visits. We conducted a quality improvement study to reduce hospital admissions of patients with MPE. METHODS Key stakeholders were surveyed, including thoracic and breast oncology teams, general pulmonary and interventional pulmonology (IP) to help identify the underlying causes and solutions. Our preintervention group consisted of 51 patients who underwent TPC placement by our IP service. In our first intervention, we reviewed referrals for MPE with the scheduling team and triaged them based on urgency. In the second intervention, we added a follow-up phone call 1 week after the initial thoracentesis performed by IP to assess for the recurrence of symptoms. RESULTS Demographic and clinical characteristics were summarised across the three groups. We evaluated the rate ratio (RR) of admissions in the intervention groups with the multivariable Poisson regression and adjusted for race, gender and cancer. Compared with the preintervention group, intervention I showed trends towards a 41% lower hospital admission rate (RR 0.59 (0.33-1.07), p=0.11). Compared with the preintervention group, intervention II showed trends towards a 40% lower hospital admission rate (RR 0.6 (0.36-0.99), p=0.07). The results did not reach statistical significance. Exploratory comparisons in readmission rates between interventions I and II showed no difference (RR 0.89 (0.43-1.79), p=0.75). CONCLUSIONS Both interventions showed trends toward fewer hospital readmissions although they were not statistically significant. Larger-size prospective studies would be needed to demonstrate the continued effectiveness of these interventions.
Collapse
Affiliation(s)
- Rebecca R Cloyes
- Pulmonary, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enambir Josan
- Pulmonary, The University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Nicholas Pastis
- Pulmonary, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jianing Ma
- Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | | | - Jing Peng
- Biostatistics, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Susan Vasko-Wood
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chelsea Mohrman
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christian Ghattas
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carolyn Presley
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alberto Revelo
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jasleen Pannu
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
5
|
Addala DN, Kanellakis NI, Bedawi EO, Dong T, Rahman NM. Malignant pleural effusion: Updates in diagnosis, management and current challenges. Front Oncol 2022; 12:1053574. [PMID: 36465336 PMCID: PMC9712949 DOI: 10.3389/fonc.2022.1053574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Malignant pleural effusion (MPE) is a common condition which often causes significant symptoms to patients and costs to healthcare systems. Over the past decade, the management of MPE has progressed enormously with large scale, randomised trials answering key questions regarding optimal diagnostic strategies and effective management strategies. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. The future goals for providing improved care for patients lies in changing the treatment paradigm from a generic pathway to personalised care, based on probability of malignancy type and survival. This article reviews the current evidence base, new discoveries and future directions in the diagnosis and management of MPE.
Collapse
Affiliation(s)
- Dinesh Narayan Addala
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Nikolaos I Kanellakis
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Tao Dong
- Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom.,Medical Research Council (MRC) Human Immunology Unit, Radcliffe Department of Medicine, Medical Research Council (MRC) Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
6
|
Aujayeb A, Wakefield D. Fatigue and malignant pleural effusions. BMJ Support Palliat Care 2021; 11:305. [PMID: 33952582 DOI: 10.1136/bmjspcare-2021-002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Donna Wakefield
- Palliative Care Department, North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
| |
Collapse
|