For mesothelioma patients with indwelling pleural catheters, new research suggests that draining them daily can improve their quality of life and may even resolve the problem faster than waiting until symptoms arise.
Pleural effusions, a buildup of fluid between the layers of the pleural membrane surrounding the lungs, is a fact of life for patients with several types of cancer, including pleural mesothelioma.
If not addressed, this fluid accumulation often leads to life-limiting side effects like chest pain, coughing, and breathlessness.
Managing Pleural Effusions from Malignant Mesothelioma
There are surgical procedures aimed at preventing pleural effusions in mesothelioma patients and resolving symptoms by physically closing the spaces where fluid accumulates. Closing up the pleural space is known as pleurodesis.
An indwelling pleural catheter is another, less invasive, option that allows a mesothelioma patient to drain the fluid at home, as needed. In some cases, the problem can even resolve on its own if the area is being drained regularly.
Now, an international research study led by the University of Western Australia has concluded that malignant mesothelioma patients with these indwelling pleural catheters can get the best results from daily drainage, rather than symptom-guided drainage.
Aggressive Versus Symptoms Guided Fluid Drainage
The study appears in the latest issue of The Lancet Respiratory Medicine and involves 87 pleural mesothelioma patients with indwelling pleural catheters who were randomly recruited between 2015 and 2017.
Half of the patients were instructed to drain their pleural catheters every day (the aggressive group) while the other half were told to drain off the fluid only when they were bothered by symptoms (the symptom-guided group).
Results Point to Benefits of Daily Drainage
It turns out that, while there was no significant difference in the breathlessness, pain, or hospitalization days for mesothelioma patients in the two groups, there were important differences in other areas.
Mesothelioma patients who were draining their catheters every day reported better overall quality of life and were more likely to experience spontaneous pleurodesis than patients who were draining as needed.
In addition the rates of infection and serious adverse events were very slightly higher among the symptom-guided patients than in the aggressive group.
In a summary of the findings, lead author Sanjeevan Muruganandan, MBBS, writes, “These data indicate that daily indwelling pleural catheter drainage is more effective in promoting spontaneous pleurodesis and might improve quality of life.”
More than 90 percent of patients with pleural mesothelioma will develop pleural effusions.
Muruganandan, S, et al, “Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial”, July 20, 2018, Lancet Respiratory Medicine, Epub ahead of print