RT Journal Article
SR Electronic
T1 S129 Indwelling pleural catheter versus talc pleurodesis in adults with malignant pleural effusion: a systematic review and meta-analysis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP A80
OP A81
DO 10.1136/thorax-2018-212555.135
VO 73
IS Suppl 4
A1 Bonello, S
A1 McCafferty, J
YR 2018
UL http://thorax.bmj.com/content/73/Suppl_4/A80.abstract
AB Background Malignant pleural effusion (MPE) is an increasingly common condition. It can cause significant distress to patients and negatively impact their quality of life.Indwelling pleural catheters (IPC) have been widely used in the management of MPE over the years, and have been shown to have similar efficacy and safety profiles to TP (the initial method of treatment suggested by the British Thoracic Society guidelines).No systematic review has yet assessed whether there is any benefit of IPC over TP with regards to patient-centred outcomes.Objectives To systematically review the available evidence comparing management of MPE with IPC versus TP, with regards to perceived dyspnea, quality of life (QoL) and number of days spent in hospital.Methods Electronic databases (PubMed, EMBASE and Web of Science) were searched for randomised controlled studies (RCT) comparing IPC with TP in MPE from 1997 until January 2018. Studies extracted were RCTs that recruited adults with symptomatic MPE treated with IPC and included a control group treated with TP. Trials had to collect data on at least one of the specified outcomes (i.e. hospital days, dyspnea and QoL) in order to be included.Data was extracted on demographics, intervention technique and outcome results at the end of follow-up. For all trials, one review author extracted the data and assessed for bias. A meta-analysis was performed and standardized mean differences (SMD) were estimated using random-effects model. Statistical heterogeneity was assessed using the I2testResults 4 completed trials, involving 347 patients, were included in this review. Meta-analysis showed no statistically significant benefit of IPC over TP with regards to dyspnea scores or QoL scores. The median number of days spent in hospital was noted to be lower in the IPC group.Conclusions Current evidence suggests that there is no benefit of IPC over TP with regards to dyspnea improvement and QoL. However, it was noted that patient treated with IPC spent less time in hospital. Overall cost was not assessed in this review, but is an avenue for further study.Due to the limited number of RCTs available, further large well-designed RCTs are required in order to better compare IPC to TP with regards to such patient-centred outcomes.