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Pro: indwelling pleural catheters cause harm to patients
Beenish Iqbal1,2, Eihab Bedawi3,4, Najib M Rahman1,2
1Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford UK.
Abstract:
Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the "ideal" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.
Insights
Indwelling pleural catheters (IPCs) for malignant pleural effusions (MPE) are not ideal. While offering symptom relief, IPCs cause complications and psychological distress, negatively impacting quality of life.
Area of Science:
- Pulmonology
- Oncology
- Palliative Care
Background:
- Malignant pleural effusions (MPE) are a common oncological complication, often recurring.
- Treatment options include talc pleurodesis and indwelling pleural catheters (IPCs).
- IPCs have gained popularity for presumed outpatient convenience.
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