• David E Ost, Carlos A Jimenez, Xiudong Lei, Scott B Cantor, Horiana B Grosu, Donald R Lazarus, Saadia A Faiz, Lara Bashoura, Vickie R Shannon, Dave Balachandran, Lailla Noor, Yousra B Hashmi, Roberto F Casal, Rodolfo C Morice, and George A Eapen.
• Chest. 2014 Jun 1;145(6):1347-56.

BackgroundMalignant 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.MethodsWith 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.ResultsA 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.ConclusionsIPC 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 RegistryClinicalTrials.gov; No.: NCT01117740; URL: www.clinicaltrials.gov.

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