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Original Research: Pulmonary Procedures |

Quality-Adjusted Survival Following Treatment of Malignant Pleural Effusions With Indwelling Pleural CathetersPleural Catheter Quality-Adjusted Survival

David E. Ost, MD, MPH, FCCP; Carlos A. Jimenez, MD, FCCP; Xiudong Lei, PhD; Scott B. Cantor, PhD; Horiana B. Grosu, MD; Donald R. Lazarus, MD; Saadia A. Faiz, MD, FCCP; Lara Bashoura, MD, FCCP; Vickie R. Shannon, MD; Dave Balachandran, MD; Lailla Noor, MD; Yousra B. Hashmi, BS; Roberto F. Casal, MD; Rodolfo C. Morice, MD, FCCP; George A. Eapen, MD
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Ost, Jimenez, Grosu, Faiz, Bashoura, Shannon, Balachandran, Noor, Morice, and Eapen and Ms Hashmi), Department of Biostatistics (Dr Lei), and Section of Health Services Research (Dr Cantor), The University of Texas MD Anderson Cancer Center; Section of Pulmonary, Critical Care, and Sleep Medicine (Drs Lazarus and Casal), Baylor College of Medicine; and Michael E. DeBakey VA Medical Center (Dr Casal), Houston, TX.

Correspondence to: David E. Ost, MD, MPH, FCCP, The University of Texas MD Anderson Cancer Center, Department of Pulmonary Medicine Unit 1462, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: dost@mdanderson.org


Funding/Support: This work was supported by a Comparative Effectiveness Research Grant, Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1347-1356. doi:10.1378/chest.13-1908
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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 < .001), but utility increased only modestly. Patients who had chemotherapy or radiation after IPC placement (P < .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 < .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.

Trial registry:  ClinicalTrials.gov; No.: NCT01117740; URL: www.clinicaltrials.gov

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