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Outpatient Management of Pleural Effusions Said to Improve Quality of Life and Reduce Costs

Outpatient Management of Pleural Effusions Said to Improve Quality of Life and Reduce Costs

An outpatient therapy for malignant pleural effusions can improve a cancer patient's quality of life while reducing hospital costs, according to Chandra Belani, md, of the University of Pittsburgh Cancer Institute (PCI). He presented his findings at the recent meeting of the American Society of Clinical Oncology in Los Angeles.

Malignancy is the most common cause of pleural effusions in adults over age 60 years, with 50% of breast cancer patients and 25% of lung cancer patients experiencing this condition.

"Up until now, this condition has been treated by inserting large-bore tubes through the chest wall and hospitalizing patients for 5 to 10 days at a time," said Dr. Belani, principal investigator of the research and co-director of the PCI's Experimental Therapeutics Program and associate professor of medicine at the University of Pittsburgh Medical Center.

"This alternative therapy could save costs related to hospitalization and allow patients to spend more time at home."

In the study, doctors inserted small-bore catheters into 28 patients with advanced cancer in an outpatient procedure. The catheters had a one-way valve system to drain fluid. When drainage slowed to less than 100 mL/d, which occurred at a median of 7 days, patients were infused intrapleurally with bleomycin (Blenoxane). This sclerosing agent fuses the outer lining of the lungs with the inner lining of the chest wall, thus eliminating the pleural space.

Outpatient sclerotherapy worked in 57% of the treated patients, with a median palliation of 4 months (range, 2 to 11 months). The patients experienced fewer side effects than would be expected in a hospitalsetting, reported Dr. Belani.

Other centers participating in the study included Duke University and the University of Maryland. The study was funded, in part, by Bristol-Myers Squibb.

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