Retrospective analysis of procedural burden and diagnostic delay in patients with malignant pleural effusion

Abstract

Introduction/Aim: Malignant pleural effusion (MPE) is associated with poor survival, disabling dyspnoea, and psychological distress. Thoracocentesis provides diagnostic yields of 40%–60%, however with the expansion of personalized oncological treatments further material is increasingly needed to determine therapeutic options. Patients often experience multiple procedures, ongoing breathlessness and diagnostic delay.

This retrospective analysis aims to quantify the number of pleural procedures that patients with MPE undergo at a regional Australian centre and the associated healthcare burden that they experience.

Methods: A retrospective review of all pleural procedures performed at Cairns Hospital between June 2019 and June 2020 was performed. Patients diagnosed with MPE were reviewed to determine demographics, presentation, number of procedures and time taken to deliver actionable histocytology and definitive pleural management.

Results: Excluding operative and trauma drains, 121 patients underwent pleural intervention over the 12-month period. Thirty-one (25.6%) of these individuals were diagnosed with MPE. Median age was 69.3 years, with median survival of 128 days. Eighty percent were referred acutely from emergency or other inpatient teams, with a median of 1 day until initial pleural intervention.

Sixteen (51.6%) of those with MPE had positive initial cytology. However, initial pleural fluid cytology was adequate to guide management in only 10 (34.4%) of diagnostic procedures. Patients underwent a median of two diagnostic procedures before actionable histocytology was delivered, with 19 (61.3%) undergoing more than one pleural procedure. Twenty-one (68%) patients underwent talc pleurodesis. Of these individuals 14 (66.7%) had freedom from re-intervention at 3 months, and 11 (52.3%) at 6 months. Median MPE related LOS was 12 days total.

Conclusion: This is, to our knowledge, the first assessment of pleural procedure burden at a regional Australian centre. The majority of patients with MPE required multiple pleural procedures and spent a considerable portion of their remaining life-expectancy in hospital. Current pathways are prolonged and are likely to lead to ongoing dyspnoea and uncertainty. New strategies to manage these patients need to be evaluated.