A NEW population-based study comparing treatments for malignant pleural effusions (MPE) has found no significant difference in post-procedure mortality between patients treated with indwelling pleural catheters (IPC) and those undergoing chemical pleurodesis. The study sheds light on real-world outcomes and variations in care for this common complication of advanced cancer.
Using provincial health data from Ontario, Canada, the study analysed 6,197 patients treated for MPE between 2015 and 2019. Among them, 77.3% received IPCs, while 22.7% underwent chemical pleurodesis. IPC insertions were more common in outpatient settings and performed primarily by pulmonologists, while pleurodesis was typically conducted by thoracic surgeons in hospitals.
Unadjusted data suggested that patients in the pleurodesis group lived longer post-procedure than those treated with IPCs (median 165 versus 81 days). However, after adjusting for baseline differences using inverse probability of treatment weighting (IPTW), the difference in mortality became insignificant (hazard ratio 1.27, 95% CI 0.95–1.69).
The findings also highlighted variations in practice patterns, with IPC usage increasing over time while pleurodesis rates declined. Notably, 35% of IPCs were removed before the patient’s death or the end of the study follow-up period.
The study underscores the need for further research into regional variations and patient-specific factors influencing treatment choice. These insights could guide personalised approaches to MPE management, focusing on patient comfort and care goals.
Reference
Kwok C et al. Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study. Respir Res. 2024;DOI: 10.1186/s12931-024-03023-6
