Outpatient Management of Pleural Effusions Said to Improve Quality of Life and Reduce Costs

An outpatient therapy for malignant pleural effusions can improvea cancer patient's quality of life while reducing hospital costs,according to Chandra Belani, md, of the University of PittsburghCancer Institute (PCI). He presented his findings at the recentmeeting of the American Society of Clinical Oncology in Los Angeles.

Malignancy is the most common cause of pleural effusions in adultsover age 60 years, with 50% of breast cancer patients and 25%of lung cancer patients experiencing this condition.

"Up until now, this condition has been treated by insertinglarge-bore tubes through the chest wall and hospitalizing patientsfor 5 to 10 days at a time," said Dr. Belani, principal investigatorof the research and co-director of the PCI's Experimental TherapeuticsProgram and associate professor of medicine at the Universityof Pittsburgh Medical Center.

"This alternative therapy could save costs related to hospitalizationand allow patients to spend more time at home."

In the study, doctors inserted small-bore catheters into 28 patientswith advanced cancer in an outpatient procedure. The cathetershad a one-way valve system to drain fluid. When drainage slowedto less than 100 mL/d, which occurred at a median of 7 days, patientswere infused intrapleurally with bleomycin (Blenoxane). This sclerosingagent fuses the outer lining of the lungs with the inner liningof the chest wall, thus eliminating the pleural space.

Outpatient sclerotherapy worked in 57% of the treated patients,with a median palliation of 4 months (range, 2 to 11 months).The patients experienced fewer side effects than would be expectedin a hospitalsetting, reported Dr. Belani.

Other centers participating in the study included Duke Universityand the University of Maryland. The study was funded, in part,by Bristol-Myers Squibb.