Quality-adjusted Survival Following Treatment of Malignant Pleural Effusions with Indwelling Pleural Catheters.
Chest. 2014 Jan 30;
Authors: Ost DE, Jimenez CA, Lei X, Cantor SB, Grosu HB, Lazarus DR, Faiz S, Bashoura L, Shannon VR, Balachandran D, Noor L, Hashmi Y, Casal RF, Morice RC, Eapen GA
Abstract
ABSTRACT BACKGROUND: Malignant pleural effusions (MPE) are a frequent cause of dyspnea in cancer patients. While indwelling pleural catheters (IPC) have been used since 1997, there are no studies of quality-adjusted survival following IPC placement.
METHODS: Prospective observational cohort study of patients with MPE treated with IPCs using a standardized algorithm. Global health-related quality of life was assessed using the SF-6D which was used to calculate utilities. Quality-adjusted life days (QALDs) were calculated by integrating utilities over time.
RESULTS: 266 patients were enrolled. Median quality-adjusted survival was 95.1 QALDs. Dyspnea improved significantly following IPC placement (p<0.001) but utility increased only modestly. Patients who had chemotherapy or radiation after IPC placement (p<0.001) and patients who were more short of breath at baseline (p=0.005) 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 that had their IPC removed. Recurrence was more common when IPC removal was due complications (p=0.04) or malfunction (<0.001) rather than decreased drainage.
CONCLUSION: IPC placement has significant beneficial effects in selected patient populations. The determinants of quality-adjusted survival in patients with MPE are complex. While 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.
REGISTRATION SITE: www.clinicaltrials.gov registration number 2010-0103-do.
PMID: 24480929 [PubMed - as supplied by publisher]