Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation

Our plain-English summary of Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation, by C.C. Hak, P. Sivakumar, L. Ahmed (BMC Pulmonary Medicine, 2016).

The study

• Authors: C.C. Hak, P. Sivakumar, L. Ahmed
• Journal: BMC Pulmonary Medicine
• Published: 2016;16:41
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study's objective is to determine if IPC insertion is safe in patients undergoing chemotherapy.

Methods: We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications.

Results: One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3%) vs 3 (4.9%) respectively, was not statistically different (Fisher's exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007).

Conclusions: This is the second largest retrospective case-control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.

In plain English

This study reviewed hospital records at Guy's and St Thomas' NHS Foundation Trust in London for 104 patients who had an indwelling pleural catheter (a long-term tube that drains fluid from around the lung) placed for malignant pleural effusion between September 2010 and December 2014. Forty-three patients received chemotherapy and 61 did not. Twelve patients had mesothelioma (3 in the chemotherapy group, 9 in the other group). The article does not report results separately for them and does not discuss asbestos. Within six months, pleural infection occurred in 4 of 43 patients (9.3%) in the chemotherapy group and 3 of 61 (4.9%) in the other group. This difference was not statistically significant (p = 0.311). Rates of cellulitis, pain and drain blockage also did not differ significantly between the groups. Six-month mortality was 35% in the chemotherapy group and 59% in the other group (p = 0.007). The authors concluded that patients undergoing chemotherapy should not be denied this catheter. They noted that the study may have been too small to detect a difference in rare complications.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case–control series (retrospective review of hospital records, described by the authors as a service evaluation)
• Who was studied: 104 patients with symptomatic malignant pleural effusion who had an indwelling pleural catheter inserted at Guy's and St Thomas' NHS Foundation Trust, London, UK, between September 2010 and December 2014. 43 were in the chemotherapy group and 61 in the non-chemotherapy group. Cancer types included lung, breast, mesothelioma (3 chemotherapy, 9 non-chemotherapy) and other cancers. Patients with benign disease were excluded.
• Exposure: Systemic chemotherapy (cytotoxic, molecular or biological therapy, excluding hormonal therapy) given while an indwelling pleural catheter was in place. Asbestos exposure was not studied.
• Main results:
  • Pleural infection at six-month follow-up occurred in 4 of 43 patients (9.3%) in the chemotherapy group and 3 of 61 (4.9%) in the non-chemotherapy group. This was not statistically different (Fisher's exact p = 0.311).
  • There was no significant difference between the groups in time to pleural infection after catheter insertion over six months (log rank p = 0.394).
  • Of the seven patients with pleural infection, three had empyema that led to removal of the drain.
  • Other complications did not differ significantly between the chemotherapy and non-chemotherapy groups: cellulitis 2 (4.7%) vs 1 (1.6%), p = 0.370; pain 2 (4.7%) vs 2 (3.3%), p = 0.550; drain blockage 1 (2.3%) vs 0 (0%), p = 0.413.
  • Six-month mortality was 35% (15 patients) in the chemotherapy group and 59% (36 patients) in the non-chemotherapy group, a significant difference (log rank p = 0.007).
• The authors' conclusion: The authors concluded that their series supports the safety of indwelling pleural catheter insertion as a first-line treatment for malignant effusion. In their view, patients undergoing chemotherapy should not be denied ambulatory management of their effusion with this catheter.
• Limitations the authors state:
  • Because adverse events are rare, the study may not have been large enough (sufficiently powered) to detect a difference between the groups.
  • The relationship between the type of chemotherapy drug and pleural infection was not the primary endpoint and requires further evaluation.

Topics

Medical terms in this study, explained in our Lexicon: Indwelling Pleural Catheter, Chemotherapy, Pleural Effusion.

Related studies

• Survival in Patients With Malignant Pleural Effusions Who Developed Pleural Infection: A Retrospective Case Review From Six UK Centers — A.C. Bibby, A.O. Clive, et al. (2015)
• Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study — M.A. Mitchell, P. Li, et al. (2019)
• Catheter tract metastasis associated with indwelling pleural catheters — R. Thomas, C.A. Budgeon, et al. (2014)
• The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital — R.C. Boshuizen, S. Onderwater, et al. (2013)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)

Browse more research in BMC Pulmonary Medicine, or return to medical research.