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Comments on Predictors of Clinical Use of Pleurodesis and/or Indwelling Pleural Catheter Therapy for Malignant Pleural EffusionBilateral Malignant Pleural Effusion Treatment FREE TO VIEW

Rogier C. Boshuizen, MD; Jacobus A. Burgers, MD, PhD; Michel M. van den Heuvel, MD, PhD
Author and Funding Information

From the Department of Thoracic Oncology, The Netherlands Cancer Institute.

CORRESPONDENCE TO: Rogier C. Boshuizen, MD, Department of Thoracic Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; e-mail: r.boshuizen@nki.nl


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;147(6):e232. doi:10.1378/chest.15-0253
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To the Editor:

With great interest we read the study by Fysh et al1 in this issue of CHEST (see page 1629). Using both patient and fluid characteristics, they have been able to select patients who are likely to undergo definitive pleural therapy. The authors claim that this knowledge allows early selection of patients, avoiding repeated pleural procedures.

As Fysh and colleagues1 commented, these results are “the real-life prescription behavior of clinicians regarding definitive therapy.” Decisions to undertake definitive therapy are made by the physician together with the patient.

We question the use of a treatment modality as primary end point, as it is influenced by the physician him or herself. Decisions whether to perform pleurodesis or to insert an indwelling pleural catheter or not are not solely based on pH, large-size pleural effusion, mesothelioma, or age. For instance, we demonstrated prospectively that changes in patient-reported dyspnea scores after therapeutic thoracentesis were related to the need for reintervention, too.2 Thus, these predictors can be used together with the objective need for definitive pleural therapy.

We prospectively collected a database from patients with pleural effusions. More than 500 patients with pleural effusions were included. As is expected from a comprehensive cancer center, the majority of patients suffered from malignant pleural effusion. After excluding nonmalignant effusions, 381 patients were enrolled for this analysis. In this cohort, the majority of patients were women (232 of 381). Median age of patients was 61 years. Pleural effusion was predominantly right-sided (213 of 381). In contrast to the population described by Fysh and colleagues,1 our database consisted of more patients suffering from breast cancer (103 of 381), as previously reported.3 At the time of analysis, 42 patients were still alive without either pleurodesis or indwelling pleural catheter insertion, 170 patients (45%) underwent definitive treatment of recurrent malignant pleural effusion, and 169 patients died without a definitive treatment of pleural effusion. No data were available on recurrent thoracenteses.

Inspired by the referred study, univariate analysis of our data showed also a significant correlation with age (OR, 0.979; P = .017). Patients with higher protein levels were more likely to undergo definitive treatment of pleural effusion at some stage during their disease (OR, 1.021; P = .048). No information was available on pleural fluid pH.

We identified one other variable. Patients with bilateral pleural effusion (52 of 381) were more prone to have definitive pleural treatment than patients with unilateral pleural effusion. (OR, 3.884; P < .0001). Aware of all potential predictive factors, clinicians may be able to inform patients in more detail on future therapies.

References

Fysh ET, Bielsa S, Budgeon CA, et al. Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. Chest. 2015;147(6):1629-1634.
 
Boshuizen RC, Vincent AD, van den Heuvel MM. Comparison of modified Borg scale and visual analog scale dyspnea scores in predicting re-intervention after drainage of malignant pleural effusion. Support Care Cancer. 2013;21(11):3109-3116. [CrossRef] [PubMed]
 
Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69(12):1098-1104. [CrossRef] [PubMed]
 

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References

Fysh ET, Bielsa S, Budgeon CA, et al. Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. Chest. 2015;147(6):1629-1634.
 
Boshuizen RC, Vincent AD, van den Heuvel MM. Comparison of modified Borg scale and visual analog scale dyspnea scores in predicting re-intervention after drainage of malignant pleural effusion. Support Care Cancer. 2013;21(11):3109-3116. [CrossRef] [PubMed]
 
Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69(12):1098-1104. [CrossRef] [PubMed]
 
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