Details

Autor(en) / Beteiligte

• Ost, David E., MD, MPH, FCCP
• Jimenez, Carlos A., MD, FCCP
• Lei, Xiudong, PhD
• Cantor, Scott B., PhD
• Grosu, Horiana B., MD
• Lazarus, Donald R., MD
• Faiz, Saadia A., MD, FCCP
• Bashoura, Lara, MD, FCCP
• Shannon, Vickie R., MD
• Balachandran, Dave, MD
• Noor, Lailla, MD
• Hashmi, Yousra B., BS
• Casal, Roberto F., MD
• Morice, Rodolfo C., MD, FCCP
• Eapen, George A., MD

Titel

Quality-Adjusted Survival Following Treatment of Malignant Pleural Effusions With Indwelling Pleural Catheters

Ist Teil von

• Chest, 2014-06, Vol.145 (6), p.1347-1356

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• 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