Introduction Malignant pleural effusion (MPE) Results in breathlessness and impairment of health related quality of life (HRQOL). Despite this there is a lack of consensus on the ideal treatment strategy to improve HRQOL.¹

Aims To perform a systematic review of the published literature to examine the efficacy of interventions in improving quality of life outcomes of patients with malignant pleural effusion.

Methods Five electronic databases were systematically searched and assessed. We included all studies evaluating HRQOL outcomes for the following interventions: therapeutic thoracocentesis, talc slurry pleurodesis (TS), indwelling pleural catheter insertion (IPC) and thoracoscopic talc poudrage pleurodesis (TTP). Meta-analysis was not performed due to substantial heterogeneity in the published data.

Results Of 56 abstracts, 16 were included in the review, all of which reported HRQOL outcomes as a secondary endpoint. Six of these studies were randomised controlled trials (RCTs) with two considered very good quality. One eligible study on therapeutic thoracocentesis outcomes was identified. 880 patients in eight studies received TTP; 475 patients in six studies received TS; 750 patients in eight studies underwent IPC insertion. TTP, TS and IPCs were all associated with modest but inconsistent improvements in HRQOL up to 12 weeks. In eight comparative studies (both randomised and non-randomised data), no intervention was significantly different to another in HRQOL outcomes at any time point. The attrition to follow up was 47.3% (582/1228) at three months.

Conclusion To our knowledge, this is the first study to systematically review the evidence for HRQOL outcomes following invasive pleural interventions for malignant pleural effusion. TTP, TS and IPCs seem to improve HRQOL in MPE over 4 to 12 weeks, but there is insufficient longer term data due to high attrition rates. Evidence for the most effective treatment strategy is limited by the small number of randomised or comparative studies.

Reference

1. Sivakumar P, Curley D, Rahman N, Lee YCG, Feller-Kopman D, West A, Ahmed L. P7Clinicians’ perspectives of health related quality of life and priorities in deciding management for malignant pleural effusion. Thorax2016;71:A86–A87.