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Quality-adjusted Survival Following Treatment of Malignant Pleural Effusions with Indwelling Pleural Catheters

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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References
1.
Davies H, Mishra E, Kahan B, Wrightson J, Stanton A, Guhan A . Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012; 307(22):2383-9. DOI: 10.1001/jama.2012.5535. View

2.
Haas A, Sterman D, Musani A . Malignant pleural effusions: management options with consideration of coding, billing, and a decision approach. Chest. 2007; 132(3):1036-41. DOI: 10.1378/chest.06-1757. View

3.
Maskell N . Treatment options for malignant pleural effusions: patient preference does matter. JAMA. 2012; 307(22):2432-3. DOI: 10.1001/jama.2012.5543. View

4.
Siegel J, Torrance G, Russell L, Luce B, Weinstein M, Gold M . Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine. Pharmacoeconomics. 1997; 11(2):159-68. DOI: 10.2165/00019053-199711020-00005. View

5.
Casal R, Bashoura L, Ost D, Chiu H, Faiz S, Jimenez C . Detecting medical device complications: lessons from an indwelling pleural catheter clinic. Am J Med Qual. 2012; 28(1):69-75. DOI: 10.1177/1062860612449475. View