Novel ways to care for patients with cancer related pleural disease
Malignant pleural effusion (MPE-a cancer induced collection of fluid between the lung and chest wall) is a common problem for people with cancer. In New Zealand cancer is the leading cause of death, and lung cancer is the most common cause of cancer death. One in four lung cancer patients will develop a pleural effusion during their disease course. The accumulated fluid cause breathlessness that requires sometime painful procedures to drain the fluid. Because the fluid tends to recur this can be a cause of multiple hospital admissions for people in the last months of their lives. Current management options for recurrent pleural effusions are suboptimal with a high failure rate, growing concerns of complications, considerable distress to patients and a significant cost to health services. Conventional treatment of MPE includes repeated drainage, or talc pleurodesis. Pleurodesis, the iatrogenic induction of pleural fibrosis to obliterate the pleural cavity, is useful only in 60% of all patients and requires a hospital admission of an average 6 days. Patients unsuitable for pleurodesis, or who have failed pleurodesis, require repeated fluid drainage procedures as in-patients, necessitating considerable health resources and patient distress. In addition conventional management of pleural effusions requires insertion of chest drains (often multiple times): the dangers of which are well recognised. Therefore there is a need for safer and more effective management of this increasingly common condition.
Indwelling pleural catheters (IPC’s) are novel devices which are suitable for all patients with MPE. IPC’s are soft flexible silicon tubes that sit permanently in the pleural space to provide easy access to drain pleural fluid without hospital admission, repeated chest drain insertion, or side effects from talc. Pilot data from Western Australia has shown that patients managed with IPC’s require significantly fewer days in hospital and require less painful pleural procedures to manage the fluid.
MRINZ is taking part in a multi-national randomised controlled trial to investigate whether IPC’s reduce hospital admissions and complications and offer a better quality of life for patients with MPE compared with talc pleurodesis. The study has been recruiting since 2012 and aims to finish recruitment by the end of 2014. Patients will continue to be followed up until mid 2015, with results available by the end of 2015.