Mesothelioma Symptoms: Best Management for Pleural Effusion

An international team of scientists is hoping to finally be able to answer the question of how often mesothelioma patients with pleural effusion should have their indwelling pleural catheters drained.

Indwelling pleural catheters (IPCs) are a novel way to treat the bothersome mesothelioma symptoms caused by a buildup of excess fluid in the space around the lungs.

Pleural effusion, as the excess fluid is called, is a common side effect of pleural mesothelioma and several other types of cancer. The most common symptom of pleural effusion is dyspnea or shortness of breath, but it can also cause chest pain and fatigue.

Mesothelioma Patients and Pleural Effusion

Indwelling pleural catheters are not the only way to deal with pleural effusion in mesothelioma patients.

A procedure called pleurodesis involves the use of talc or a chemical irritant to to help close up the space where the fluid collects so that no new fluid can build up there. Pleurodesis is a serious procedure with its own set of risks and sometimes has to be repeated.

Another method for removing pleural effusion in mesothelioma patients is to draw it off with a needle. Although effective, this method also has to be repeated when the fluid builds up again, as it inevitably does.

Because they stay in place, IPCs offer an easier and, some believe, safer way to regularly drain lung fluid, either in the clinic or by the patient at home.

IPC Drainage – How Much is Enough?

But mesothelioma experts remain divided over how often IPCs should be drained. Daily draining can be costly if done in the clinic and can increase the risk of certain complications. Instead, some experts advocate drainage only when the mesothelioma patient develops symptoms, which could be weekly or even monthly.

The Protocol of the Australasian Malignant Pleural Effusions-2 (AMPLE-2) trial aims to help determine the optimal IPC drainage schedule for maximum safety, efficiency, and symptom relief for people with mesothelioma and other cancers.

Patients with malignant pleural effusions will be randomized to have either daily or symptom-guided drainage regimens after IPC insertion.

“The primary outcome is the mean daily dyspnea score, measured by a 100 mm visual analogue scale (VAS) over the first 60 days,” explains lead investigator Dr. Maree Azzopardi of Sir Charles Gairdner Hospital in Perth. 

The team also plans to measure the impact of IPC drainage schedule on physical activity levels, rate of spontaneous pleurodesis, hospital admission days, healthcare costs, complications, and quality of life.

The results will be published in peer-reviewed journals.

Source:

Azzopardi, M, et al, “Protocol of the AUstralasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomized study of aggressive versus symptoms-guided drainage via indwelling pleural catheters.”, July 5, 2016, BMJ Open