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| |  DG DISPATCH - LUNG CANCER: Hospitalization Not Needed For Management of Malignant Pleural Effusions By Jill Stein Special to DG News
TOKYO, JAPAN -- September 12, 2000 -- Canadian investigators are reporting favourable results with an in-dwelling cuffed silastic catheter, which permits patients with malignant pleural effusions to undergo palliative treatment on an outpatient basis. The findings are from a study in which 133 catheters commonly employed for peritoneal dialysis were placed in 121 patients. Seven patients had benign effusions. Results were presented at the Ninth World Conference on Lung Cancer. "Treatment of malignant pleural effusions in cancer patients with end-stage disease is often associated with high morbidity and repeated or prolonged hospital stays," explained Dr. Michael Johnston, with Princess Margaret Hospital in Toronto. "Treatment options include repeated thoracentesis, tube thoracostomy with chemical sclerosis, or pleuroperitoneal shunting," he added. "The limited efficacy of these treatment options (i.e., a reported minimum 20 percent failure rate) further diminishes the remaining quality of life for these end-stage stage cancer patients, whose life expectancy is approximately three to eleven months." Patients in their series were followed by their oncologists and returned to the clinic only when problems developed with the catheter or if their symptoms persisted. Ninety-nine patients required no further treatment for their pleural effusions. Eleven patients were treated with more than one catheter, and seven patients had catheters placed in both the left and right pleural spaces for bilateral pleural effusions. Three patients had catheters placed in both chests simultaneously to treat bilateral syncronous pleural effusions. Four patients needed to have their catheter repositioned due to loculated effusions. Twenty two patients required further treatment or removal of the catheter because of continued symptoms or complications. The indications for catheter insertion have evolved over the six-year study period. In the last 60 patients, a more standardized approach was used. Poor risk, severely debilitated patients underwent catheter insertion alone under local anesthesia and were discharged home the same day. Good risk patients underwent video-assisted thoracoscopy and talc poudrage. If the lung did not expand, a catheter was then placed. Dr. Johnston emphasized that the use of an in-dwelling pleural catheter to palliate patients with malignant pleural effusions is a less invasive treatment approach than standard methods. Importantly, the catheter minimizes morbidity and eliminates the prolonged hospital stay associated with chest tube insertion and chemical pleurodesis. Also, catheter placement can be performed as an outpatient procedure under local anesthesia. Finally, he noted that intermittent drainage of fluid is performed in the patient’s home either by community nurses or by the patient’s family, which provides immediate symptom relief and eliminates the need for repeat hospital visits. Also, the portability of the equipment enables the patient to carry on with daily home activities.
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