Pleural Catheters May Shorten Hospital Time for Mesothelioma Patients

Mesothelioma patients with a buildup of lung fluid may spend less time in the hospital if they are treated with an indwelling pleural catheter than if they undergo talc pleurodesis.

An international team of researchers in Australia, New Zealand, Singapore and Hong Kong have just published the results of a two-year clinical trial of 146 pleural mesothelioma patients who were suffering from the symptoms of malignant pleural effusion.

Patients were randomly selected to receive either an indwelling pleural catheter to continually drain off the pleural fluid or talc pleurodesis, a procedure designed to close up the pleural space and prevent fluid from collecting there.

Their findings suggest that indwelling pleural catheters may have advantages over talc pleurodesis in the treatment of this common mesothelioma symptom.

Pleural Effusion in Malignant Pleural Mesothelioma

The pleura is the two-layered membrane that lines the surface of the lungs. It is also the place where pleural mesothelioma tumors start.

Normally, there is only a small amount of fluid between the layers, which allows the lungs to move freely inside the chest cavity during breathing.

Pleural effusion happens when additional fluid begins to collect in this space, making it harder for the lungs to expand and causing shortness of breath. It is a common side effect of malignant mesothelioma and several other types of cancer.

Treatments for Mesothelioma-Related Pleural Effusion

There are several ways of dealing with mesothelioma-related pleural effusion and the uncomfortable symptoms it can cause.

One option is for the fluid to be drained off periodically by a doctor. Another solution is a surgical procedure (pleurodesis) that uses a chemical or an irritant like talc to prompt the body to fill in the pleural space, making future fluid buildup less likely.

A third solution is to implant a catheter that stays in place, allowing the mesothelioma patient to periodically drain off the fluid at home. This is known as an indwelling pleural catheter or IPC.

Shorter Hospital Stays for IPC Patients

In the newly-released study, mesothelioma patients who received IPCs spent fewer days in the hospital than those who underwent pleurodesis. The IPC group had a median of just one effusion-related hospital day versus four for those who had pleurodesis.

Patients with indwelling pleural catheters were also less likely to need additional invasive procedures for lung fluid drainage. However, neither procedure emerged as a clear winner when it came to mesothelioma symptom management.

“There were no significant differences in improvements in breathlessness or quality of life offered by indwelling pleural catheter or talc pleurodesis,” reports study author Rajesh Thomas, PhD, with the department of respiratory medicine at Sir Charles Gairdner Hospital in Perth.

In addition, the mesothelioma patients with IPCs had almost twice as many “adverse events” related to the procedure as those who had pleurodesis.

Given these facts, the researchers conclude that “the magnitude of the difference is of uncertain clinical importance”, suggesting that the decision as to how to treat pleural effusion is still best decided on an individual basis by mesothelioma patients and their doctors.

Source:

Thomas, R, et al, “Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion: The AMPLE Randomized Clinical Trial”, November 21, 2017, Journal of the American Medical Association, pp. 1903-1912