Draining off excess lung fluid with an indwelling catheter may be a better way to deal with this mesothelioma symptom than surgery, according to a new study.
Pleural effusion, a build-up of fluid between the two layers of the lining around the lungs, is a common side effect of several cancers, including malignant pleural mesothelioma. Approximately half of all patients with metastatic cancer develop pleural effusion, which can have a dramatic impact on quality of life by inhibiting a person’s ability to breathe freely. Many mesothelioma patients also experience chest pain and fatigue as a result of pleural effusion. If untreated, pleural effusion can lead to pneumonia or lung collapse.
Some mesothelioma patients with pleural effusion are treated with pleurodesis, a hospital procedure that causes the layers of the lung lining to stick together, eliminating space for fluid buildup. While this procedure may correct the problem and relieve symptoms, it is a more invasive and expensive treatment approach. In addition, a recent Australian study found that just over 30 percent of pleurodesis procedures performed on mesothelioma patients were incomplete and required further drainage.
But mesothelioma researchers in The Netherlands say another solution, which involves placing a drainage tube in the pleural space and leaving it in place, may be just as effective and less expensive in the long run. They found this to be true, even though Dutch insurance companies do not reimburse for such drainage catheters, either as a first-line treatment or after failed pleurodesis. Indwelling pleural catheters (IPCs) are increasingly popular for pleural effusion treatment in mesothelioma.
To calculate the costs of IPCs versus pleurodesis, the researchers examined the medical records of patients with mesothelioma and other cancers with pleural effusion. They found that the cost of placing a drainage catheter and dealing with any complications (four patients were hospitalized for problems), was still less than the hospitalization costs for pleurodesis treatment. Most mesothelioma patients had no trouble with the drainage catheter and did not need help from a specialized home care nurse.
“Direct costs for IPC placement turn out to be acceptable when compared with estimated hospitalization costs for pleurodesis treatment,” conclude the authors in the journal Respiration. They recommend randomized controlled trials to confirm their findings for malignant pleural mesothelioma patients.
Boschuizen, RC, et al, “The Use of Indwelling Pleural Catheters for the Management of Malignant Pleural Effusion – Direct Costs in a Dutch Hospital”, July 23, 2013, Respiration, Epub ahead of print.