Walker, S., Zubrinic, M., Massey, C., Shargall, Y., Bedard, E., & Darling, G. (2016). A prospective study of patient-centred outcomes in the management of malignant pleural effusions. International Journal of Palliative Nursing, 22, 351–358.

To evaluate patient-reported satisfaction with treatment, quality of life (QoL), and dyspnea outcomes for four treatment strategies for malignant pleural effusion.

Four treatment regimens (indwelling pleural catheter [IPC] alone, video-assisted thoracic surgery [VATS] and IPC, bedside chest tube and talc slurry; and VATS with talc poudrage) for malignant pleural effusion (MPE) were evaluated using patient-reported outcome tools. The primary outcome of treatment satisfaction was measured immediately after treatment, as well as two and six weeks post-completion using the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS) tool. Secondary outcomes of improvement in dyspnea and QoL were measured at baseline, two, and six weeks post-treatment. Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal) was used to measure QoL; the London Chest Activity of Daily Living scale was used to measure dyspnea.

• N = 104   
• AGE: Median age = 61, range = 26-89
• MALES: 36%  
• FEMALES: 64%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Confirmed diagnosis of cancer with symptomatic pleural effusion confirmed on chest x-ray included; those with endobronchial obstruction, empyema, allergy to talc, or prior treatment for ipsilateral pleural effusion excluded. 
• OTHER KEY SAMPLE CHARACTERISTICS: Must be able to read and write in English. Lung cancer most common, breast cancer second most common diagnoses

• SITE: Multi-site   
• SETTING TYPE: Inpatient urban hospitals
• LOCATION: Canada

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS:  Palliative care

Prospective cohort study

Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal) was used to measure health-related QoL; the London Chest Activity of Daily Living scale was used to measure dyspnea; Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS) was used to measure treatment satisfaction. Post-treatment pain measured on 0-10 scale, and ECOG performance status measurement was added mid-study.

No statistical difference in patient-reported outcomes was identified when comparing results for each of the four treatment modalities: indwelling pleural catheter (IPC), video assisted thoracic surgery (VATS), chest tube and talc slurry; and VATS talc poudrage. There was a statistically significant trend of improvement in overall FACIT-PAL score (p < 0.0001) and trend in decreasing breathlessness measured with both London Chest Activity Daily Living scale (p = 0.003) and FACIT-Pal shortness of breath score (p = 0.0007) when evaluating all study participants as a whole; there was no statistical difference between groups. Treatment satisfaction at six-week point was highest with VATS plus pleurodesis group and lowest with chest tube group; however, difference was NOT statistically significant.

Each of the treatment options for treating malignant pleural effusions are efficacious in improving health-related QoL and decreasing breathlessness with no statistically significant difference in patient-reported satisfaction when comparing each intervention.

• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Measurement validity/reliability questionable
• Other limitations/explanation: The subject accrual period was from 2007 to 2013; variability in individuals performing interventions and setting (some outpatient, some inpatient). Difficulty recruiting from multicultural population due to inability to read/write in English influenced participant selection. Sample size small at 104. London Chest Activity of Daily Living scale reliability and validity only tested with COPD population, not MPE.

Nurses educating individuals living with symptomatic malignant pleural effusions need to understand and share data regarding the experience of other patients; patients will benefit from knowledge that other individuals with MPE report an improvement in health-related QoL and a decrease in breathlessness regardless of MPE treatment option utilized. More research is needed in development of measurement tools for breathlessness in individuals with MPE. Additional studies with larger sample sizes are needed to evaluate treatment of dyspnea in patients with cancer because dyspnea is commonly experienced by individuals with advanced disease.