Advertisement

Deciding Between Two Therapies for Dyspnea in Malignant Pleural Effusions

Summary and Comment |
June 28, 2012

Deciding Between Two Therapies for Dyspnea in Malignant Pleural Effusions

  1. Patricia Kritek, MD

Draining and pleurodesis versus indwelling pleural catheters: Outcomes were generally equivalent.

  1. Patricia Kritek, MD

Malignant pleural effusions can cause disabling dyspnea and chest pain. Traditional treatment has been drainage and pleurodesis; however, use of small indwelling pleural catheters has increased recently. It is unclear which procedure produces better symptom relief.

In this multicenter U.K. trial, 106 patients with malignant pleural effusions were randomized to talc pleurodesis or catheter placement. During the first 42 days, patients in both groups had similar significant improvements in dyspnea. At 6 months, the catheter group had significantly better dyspnea scores (a 14-mm difference on a 100-mm visual analog scale), but it is noteworthy that only 54 patients were included in this analysis, as nearly half the patients had died. Patients in both groups had similar slight improvements in chest pain and similar quality-of-life scores. Complications, mainly infections or catheter blockage, were more common in the catheter group (40% vs. 13%). At 1 year, pleurodesis patients had spent a median of 4.5 days in the hospital versus 1 day for catheter recipients.

Comment

No clear winner emerged from this study –– both procedures effectively improved dyspnea. Choice of treatment for malignant pleural effusion should be guided by patient preference. If being at home is a priority for a patient, a pleural catheter is probably a better choice, although the higher risk for subsequent infection or blockage should be mentioned during counseling.

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement