Quality-adjusted survival following treatment of malignant pleural effusions with indwelling pleural catheters.
BACKGROUND
Malignant 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.


METHODS
With 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.


RESULTS
A total of 266 patients were enrolled. Median quality-adjusted survival was 95.1 QALDs. Dyspnea improved significantly following IPC placement (P &lt; .001), but utility increased only modestly. Patients who had chemotherapy or radiation after IPC placement (P &lt; .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 &lt; .001) rather than to decreased drainage.


CONCLUSIONS
IPC 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.


BACKGROUND
ClinicalTrials.gov; No.: NCT01117740; URL: www.clinicaltrials.gov.
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center. Electronic address: dost@mdanderson.org.
David E
DE
Ost
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Carlos A
CA
Jimenez
Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine.
Xiudong
X
Lei
Michael E. DeBakey VA Medical Center, Houston, TX.
Scott B
SB
Cantor
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Horiana B
HB
Grosu
Michael E. DeBakey VA Medical Center, Houston, TX.
Donald R
DR
Lazarus
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Saadia A
SA
Faiz
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Lara
L
Bashoura
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Vickie R
VR
Shannon
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Dave
D
Balachandran
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Lailla
L
Noor
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Yousra B
YB
Hashmi
Michael E. DeBakey VA Medical Center, Houston, TX.
Roberto F
RF
Casal
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
Rodolfo C
RC
Morice
Department of Pulmonary Medicine, Department of Biostatistics, Section of Health Services Research, The University of Texas MD Anderson Cancer Center.
George A
GA
Eapen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D035422:Pleural Cavity; D016066:Pleural Effusion, Malignant / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult