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Observational Study
. 2014 Jun;145(6):1347-1356.
doi: 10.1378/chest.13-1908.

Quality-adjusted survival following treatment of malignant pleural effusions with indwelling pleural catheters

David E Ost  1 , Carlos A Jimenez  2 , Xiudong Lei  3 , Scott B Cantor  4 , Horiana B Grosu  2 , Donald R Lazarus  4 , Saadia A Faiz  2 , Lara Bashoura  2 , Vickie R Shannon  2 , Dave Balachandran  2 , Lailla Noor  2 , Yousra B Hashmi  2 , Roberto F Casal  4 , Rodolfo C Morice  2 , George A Eapen  2
Affiliations
Observational Study

Quality-adjusted survival following treatment of malignant pleural effusions with indwelling pleural catheters

David E Ost et al. Chest. 2014 Jun.

Abstract

Background: Malignant pleural effusions (MPEs) are a frequent cause of dyspnea in patients with cancer. Although indwelling pleural catheters (IPCs) have been used since 1997, there are no studies of quality-adjusted survival following IPC placement.

Methods: With a standardized algorithm, this prospective observational cohort study of patients with MPE treated with IPCs assessed global health-related quality of life using the SF-6D to calculate utilities. Quality-adjusted life days (QALDs) were calculated by integrating utilities over time.

Results: A total of 266 patients were enrolled. Median quality-adjusted survival was 95.1 QALDs. Dyspnea improved significantly following IPC placement (P < .001), but utility increased only modestly. Patients who had chemotherapy or radiation after IPC placement (P < .001) and those who were more short of breath at baseline (P = .005) had greater improvements in utility. In a competing risk model, the 1-year cumulative incidence of events was death with IPC in place, 35.7%; IPC removal due to decreased drainage, 51.9%; and IPC removal due to complications, 7.3%. Recurrent MPE requiring repeat intervention occurred in 14% of patients whose IPC was removed. Recurrence was more common when IPC removal was due to complications (P = .04) or malfunction (P < .001) rather than to decreased drainage.

Conclusions: IPC placement has significant beneficial effects in selected patient populations. The determinants of quality-adjusted survival in patients with MPE are complex. Although dyspnea is one of them, receiving treatment after IPC placement is also important. Future research should use patient-centered outcomes in addition to time-to-event analysis.

Trial registry: ClinicalTrials.gov; No.: NCT01117740; URL: www.clinicaltrials.gov.

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Figures

Figure 1.
Figure 1.
Drainage algorithm of pleural fluid after IPC insertion. CXR = chest radiograph; IPC = indwelling pleural catheter.
Figure 2.
Figure 2.
Box plot of utilities for patients alive with an IPC for malignant pleural effusions. See Figure 1 legend for expansion of abbreviation.
Figure 3.
Figure 3.
Kaplan-Meier plot of time to death based on whether patients received chemotherapy or radiation after IPC placement. Chemo = chemotherapy. See Figure 1 legend for expansion of other abbreviation.
Figure 4.
Figure 4.
Box plot of Borg score for patients alive with IPC for malignant pleural effusions. See Figure 1 legend for expansion of abbreviation.
Figure 5.
Figure 5.
Kaplan-Meier plot of time to any complication stratified by whether patients received chemotherapy or radiation after IPC placement. See Figure 1 and 3 legends for expansion of abbreviations.
Figure 6.
Figure 6.
Kaplan-Meier plot of time to fluid recurrence requiring intervention following IPC removal stratified by reason for removal. See Figure 1 legend for expansion of abbreviation.
Figure 7.
Figure 7.
Cumulative incidence of competing risks.
See this image and copyright information in PMC

References

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