“Our results demonstrate that both strategies are highly effective treatments for relieving dyspnea with more than 75% achieving a clinically significant improvement,” the researchers report in the Journal of the American Medical Association online May 20. “As such, IPCs cannot be advocated as a superior treatment to talc pleurodesis for palliation of symptoms.”
Dr. Najib M. Rahman, at the University of Oxford, Churchill Hospital, and colleagues note that guidelines recommend chest tube placement and pleurodesis as first-line treatment for malignant pleural effusion, but indwelling pleural catheters are increasingly used as an alternative.
To determine whether IPCs are more effective, the team conducted a randomized trial with 106 patients with malignant pleural effusion who had not had prior pleurodesis. Indwelling pleural catheters were inserted on an outpatient basis in 52 of the patients, with subsequent home drainage, while 54 patients were admitted for chest tube insertion and talc pleurodesis.
During follow-up for 6 weeks, the patients recorded dyspnea levels daily on a 100-mm visual analog scale. The investigators found that dyspnea improved significantly in both groups, with no significant difference in mean dyspnea VAS scores — 24.7 mm in the IPC group and 24.4 mm in the talc group.
Secondary outcomes of improvement in chest pain and quality of life were also not significantly different between the two treatment groups, according to the report.
While adverse events rates were higher in the IPC group than the pleurodesis group (40% vs 13%; odds ratio 4.70; p=0.002), fewer IPC patients than talc patients required further pleural treatments (6% vs 22%; odds ratio 0.21; p-0.03), Dr. Rahman and colleagues report.
They conclude that IPCs are not superior to talc pleurodesis. “However,” they add, “other factors such as length of hospital stay, adverse events, and the inconvenience of on-going drainage may be important factors in patient and physician choice of initial treatment modality in malignant pleural effusion, and this study provides initial data on which to base some of these choices.”