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Sivakumar P, Fitzgerald DB, Ip H, Rao D, West A, Noorzad F, Wallace D, Haris M, Prudon B, Hettiarachchi G, Jayaram D, Goldring J, Maskell N, Holme J, Sharma N, Ismail I, Kadwani O, Simpson S, Read CA, Sun X, Douiri A, Lee YCG, Ahmed L. The impact of outpatient versus inpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial. Eur Respir J 2024; 63:2201215. [PMID: 37996243 DOI: 10.1183/13993003.01215-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The principal aim of malignant pleural effusion (MPE) management is to improve health-related quality of life (HRQoL) and symptoms. METHODS In this open-label randomised controlled trial, patients with symptomatic MPE were randomly assigned to either indwelling pleural catheter (IPC) insertion with the option of talc pleurodesis or chest drain and talc pleurodesis. The primary end-point was global health status, measured with the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) at 30 days post-intervention. 142 participants were enrolled from July 2015 to December 2019. RESULTS Of participants randomly assigned to the IPC (n=70) and chest drain (n=72) groups, primary outcome data were available in 58 and 56 patients, respectively. Global health status improved in both groups at day 30 compared with baseline: IPC (mean difference 13.11; p=0.001) and chest drain (mean difference 10.11; p=0.001). However, there was no significant between-group difference at day 30 (mean intergroup difference in baseline-adjusted global health status 2.06, 95% CI -5.86-9.99; p=0.61), day 60 or day 90. No significant differences were identified between groups in breathlessness and chest pain scores. All chest drain arm patients were admitted (median length of stay 4 days); seven patients in the IPC arm required intervention-related hospitalisation. CONCLUSIONS While HRQoL significantly improved in both groups, there were no differences in patient-reported global health status at 30 days. The outpatient pathway using an IPC was not superior to inpatient treatment with a chest drain.
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Affiliation(s)
- Parthipan Sivakumar
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
- Western Sydney University, Sydney, Australia
- P. Sivakumar and L. Ahmed are joint first authors
| | - Deirdre B Fitzgerald
- Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Hugh Ip
- Centre for Respiratory Medicine, Royal Free Hospital, London, UK
| | - Deepak Rao
- Department of Thoracic Medicine, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, UK
| | - Alex West
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
| | | | - Deirdre Wallace
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
| | - Mohamed Haris
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Benjamin Prudon
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | | | | | - James Goldring
- Centre for Respiratory Medicine, Royal Free Hospital, London, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Jayne Holme
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Neel Sharma
- Respiratory Medicine, East Sussex NHS Trust, Eastbourne, UK
| | - Iyad Ismail
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Owais Kadwani
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
| | - Sanchez Simpson
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
| | - Catherine A Read
- Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
| | - Xiaohui Sun
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Abdel Douiri
- Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
| | - Y C Gary Lee
- Institute for Respiratory Health, University of Western Australia, Nedlands, Australia
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Liju Ahmed
- Department of Thoracic Medicine, Guy's and St Thomas' NHS Trust, London, UK
- Department of Thoracic Medicine, King Faisal Specialist Hospital and Research Centre, Madinah, Kingdom of Saudi Arabia
- P. Sivakumar and L. Ahmed are joint first authors
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Sivakumar P, Jayaram D, Rao D, Dhileepan V, Ahmed I, Ahmed L. Ultrasound-Guided Abrams Pleural Biopsy vs CT-Guided Tru-Cut Pleural Biopsy in Malignant Pleural Disease, a 3-Year Follow-up Study. Lung 2016; 194:911-916. [PMID: 27540734 PMCID: PMC5093211 DOI: 10.1007/s00408-016-9933-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/07/2016] [Indexed: 11/26/2022]
Abstract
Purpose Conventional Abrams biopsy shows low sensitivity in suspected malignant pleural disease. There are limited data on the improvement in sensitivity by adding in image guidance. This retrospective study compares the diagnostic sensitivity of Abrams biopsy using ultrasound guidance with CT-guided Tru-Cut biopsy in suspected malignant pleural disease. Methods Data were collected from 2006 to 2012 of patients who underwent image-guided biopsies for suspected non-tuberculous pleural disease. Data were collected on the result of the initial biopsy and final patient diagnosis as of June 2015. Results Sixty-three patients underwent image-guided Abrams biopsy and 29 underwent CT-guided Tru-Cut biopsies. The sensitivity of Abrams was 71.43 % compared to 75 % in the CT-guided Tru-Cut group. Specificity was 100 % in both groups. Conclusions Image-guided Abrams biopsies demonstrate comparable diagnostic sensitivity in malignant pleural disease to CT-guided Tru-Cut biopsy. Electronic supplementary material The online version of this article (doi:10.1007/s00408-016-9933-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Deepak Rao
- Princess Royal University Hospital, Orpington, UK
| | | | - Irfan Ahmed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liju Ahmed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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