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Management of malignant pleural effusion: challenges and solutions

Authors Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I

Received 24 January 2017

Accepted for publication 27 March 2017

Published 23 June 2017 Volume 2017:9 Pages 229—241


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Alexandra R. Fernandes

Erika Penz,1 Kristina N Watt,1 Christopher A Hergott,2 Najib M Rahman,3 Ioannis Psallidas3

1Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, 2Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada; 3Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK

Abstract: Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches.

Keywords: malignant pleural effusion, therapeutics, cost-effectiveness, quality of life

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