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Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

2014; BMJ; Volume: 4; Issue: 11 Linguagem: Inglês

10.1136/bmjopen-2014-006757

2044-6055

Edward Fysh, Rajesh Thomas, Catherine Read, B Lam, Elaine Yap, Fiona Horwood, Pyng Lee, Francesco Lo Piccolo, Ranjan Shrestha, Luke Garske, David Lam, Andrew Rosenstengel, Michael Bint, Kevin Murray, Nicola Smith, Gary Lee,

Occupational and environmental lung diseases

Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management but requires hospitalisation (and substantial healthcare resources), can cause significant side effects, and has a suboptimal success rate. Indwelling pleural catheters (IPCs) allow ambulatory fluid drainage without hospitalisation, and are increasingly employed for management of malignant effusions. Previous studies have only investigated the length of hospital care immediately related to IPC insertion. Whether IPC management reduces time spent in hospital in the patients' remaining lifespan is unknown. A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital, reduce costs and save healthcare resources.