Quality of life after interventions for malignant pleural effusions: a systematic review

Abstract

BackgroundMalignant pleural effusion (MPE) results in breathlessness and impairment of health-related quality of life (HRQOL). This study reviews the existing literature on HRQOL following invasive interventions in MPE.MethodsFive electronic databases were systematically searched and assessed three times during the review process and last completed on 15 June 2018. We included all studies evaluating HRQOL outcomes for the following interventions: therapeutic thoracocentesis, talc slurry (TS) pleurodesis, indwelling pleural catheter (IPC) insertion and thoracoscopic talc poudrage (TTP) pleurodesis. Meta-analysis was not performed due to substantial heterogeneity in the published data.Results17 studies were included in the review reporting HRQOL outcomes in 2515 patients. TTP, TS and IPC were associated with modest but inconsistent improvements in HRQOL up to 12 weeks. No intervention was significantly different from another in HRQOL outcomes at any time point. The attrition to follow-up was 48.3% (664/1374) at 3 months. The overall quality of studies was inadequate.ConclusionTTP, TS and IPC seem to improve HRQOL in MPE over 4–12 weeks, but there are insufficient longer term data due to high attrition rates. Evidence on the most effective treatment strategy is limited by the small number of randomised or comparative studies.Trial registration numberCRD42016051003.

Postoperative outcome after palliative treatment of malignant pleural effusion

“…Also, the psychological effect of a catheter that may remain in place for the rest of the patient's life is absent, as is the risk of infection associated with a tunneled catheter and regular nursing care. In a meta‐analysis of 17 studies and 2515 patients, Savikumar et al found no significant difference in quality of life between thoracoscopic talc pleurodesis and IPC 19 . There are already retrospective as well as prospective studies to compare VATS talc pleurodesis and the implantation of an IPC in the treatment of MPE.…”

Malignant Pleural Effusions Impact on Fatigue (IMPE-F): A Prospective Observational Cohort Pilot Study

“…The attrition rate of MPE is high [1][2][3]5] and it is very likely that participants may die during the follow up period. A previous systematic review of QoL after interventions for MPEs found a short follow up period [5].…”

“…The attrition rate of MPE is high [1][2][3]5] and it is very likely that participants may die during the follow up period. A previous systematic review of QoL after interventions for MPEs found a short follow up period [5]. Every effort will be made to check using the electronic patient records that patients have not been admitted to hospital or have died to avoid calling and cause family distress.…”

“…The quality of life of patients with MPE has been studied before and recently summarized in a systematic review [5]. Sivakumar et al, found that pleural interventions improve health related quality of life at 4-12 weeks but the studies had high attrition rates.…”

Pleural Manometry—Basics for Clinical Practice

“…Dependent on patients' clinical context, predicted life expectancy, preferences, and the ability of the lung to re-expand, three therapeutic approaches can be offered: (1) serial thoracenteses, (2) pleurodesis, and (3) indwelling pleural catheter (IPC) insertion. Both pleurodesis and IPC are preferred as "definitive" procedures [24•] resulting in improvement of health-related quality of life [25] and reducing the risk of future pleural intervention. Assessment of lung expandability is crucial when pleurodesis is considered a therapeutic option as pleural apposition is a key prerequisite for effective pleural adhesion.…”