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Chest. 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.

Author information

1
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center. Electronic address: dost@mdanderson.org.
2
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
3
Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine.
4
Michael E. DeBakey VA Medical Center, Houston, TX.

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.

PMID:
24480929
PMCID:
PMC4694176
DOI:
10.1378/chest.13-1908
[Indexed for MEDLINE]
Free PMC Article

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