A prospective study of patient-centred outcomes in the management of malignant pleural effusions

BACKGROUND: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. To date, satisfaction with treatment options has not been evaluated. PURPOSE: To evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. DESIGN: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage. SETTING: A total of 104 participants were treated across four acute care teaching hospitals in a large Canadian city. MEASUREMENTS: Patient-reported outcomes were assessed using functional assessment of chronic illness therapy-palliative (FACIT-PAL), London Chest Activity of Daily Living scale and FACIT-treatment satisfaction questionnaires. RESULTS: No significant difference was identified between the four treatments based on patient-reported outcomes. VATS talc poudrage provided the most durable improvement. At the 6-week post-treatment time point, the highest patient satisfaction was noted in patients who received VATS and talc pleurodesis, lowest satisfaction in patients with chest tube and talc pleurodesis; however, the differences were not statistically significant (p=0.20). VATS and talc pleurodesis had the highest scores at 6 weeks for recommendation of treatment to others; however, the comparison with other treatment groups was not statistically significant (p=0.22). For FACIT-PAL, total scores when analysed as one group, there was a statistically significant increasing trend (indicating improvement) (p<0.0001). Breathlessness, measured using the London Chest Activity of Daily Living scale, indicated a statistically decreasing trend, suggesting an improvement (p=0.0003). There was no statistically significant difference in trends over time between the four treatment groups. CONCLUSIONS: While all treatment options addressed the patients' symptoms and relieved dyspnoea, an IPC offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction.