Management of Malignant Pleural Effusions in U.S. Veterans: A Retrospective Review

Abstract

Purpose: To compare malignant pleural effusion (MPE) treatment outcomes and complications among patients receiving indwelling pleural catheter (IPC), talc pleurodesis (TPS), or dual therapy. Outcomes were determined by measuring length of stay (LOS) and post-procedure dyspnea scores. Complications were measured by comparing intervention failures and adverse events.

Methods: The Veterans Affairs' Corporate Data Warehouse was utilized to retrospectively review the charts of 314 MPE subjects. Dyspnea scores were estimated by researchers and LOS was determined by adding the duration of stay for all admissions post procedure. Complications were recorded through chart review.

Results: IPC exhibited higher failure rates than the other approaches 1 year post intervention. Pneumonia/chest infection rate and lung entrapment were also more prevalent. There was no significant difference in dyspnea rates. LOS illustrated a significant difference between groups, with talc patients spending a median of 7 days in the hospital immediately post procedure, while IPC and IPC + TPS patients spent a median of 3 and 2 days, respectively.

Conclusion: Patients receiving IPC or combination treatment spend fewer days in the hospital than TPS patients. However, IPC appears to be associated with more adverse events and higher long-term failure rates than other management strategies.

Keywords: indwelling pleural catheter; malignant pleural effusion; talc pleurodesis.

Fig. 1. Survival rate of MPE patients separated into their respective groups of IPC, IPC + TPS, and TPS up to 365 days following treatment. This was completed by using a Cox regression model and adjusting for intervention type, baseline ECOG, and dyspnea scores. The black line represents the TPS group, dark gray is the combination group, and light gray corresponds to the IPC group. There was no statistically significant difference in survival among the groups. MPE: malignant pleural effusion; IPC: indwelling pleural catheter; TPS: talc pleurodesis; ECOG: Eastern Cooperative Oncology Group

Fig. 2. Changes in dyspnea score among the treatment groups both at baseline and then following intervention in quartiles. The black column corresponds to baseline, while each gray column indicates a quartile following intervention with darkest gray being Q1 and the lightest gray being Q4. The baseline score was determined by the dyspnea score closest to procedure date. Quartiles were made up of 100 days. Improvement in dyspnea was noted in each group following their respective treatment, as expected. However, there was neither statistically significant nor clinically relevant difference in dyspnea improvement when the three groups were compared.

Fig. 3. Average total hospital stay post procedure in each group. The black column represents the TPS group with an average of 7 days post-procedure hospital stay. The middle dark gray column shows the 2-day average post-procedure stay of the IPC + TPS group, and the light gray column represents the IPC group with an average of 3 days in the hospital post procedure. This result was statistically significant with p equaling <0.05 among all groups. TPS: talc pleurodesis; IPC: indwelling pleural catheter