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Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study
Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting. We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs...
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| Published in: | Respiratory research 2024-11, Vol.25 (1), p.409-11, Article 409 |
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| creator | Kwok, Chanel Thavorn, Kednapa Amjadi, Kayvan Aaron, Shawn D Kendzerska, Tetyana |
| description | Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting.
We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs.
We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline.
We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p |
| doi_str_mv | 10.1186/s12931-024-03023-6 |
| format | article |
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We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs.
We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline.
We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48-457] days vs. 81[IQR:29-256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95-1.69). 35% of IPCs were removed prior to death or end of follow-up.
After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes.</description><identifier>ISSN: 1465-993X</identifier><identifier>ISSN: 1465-9921</identifier><identifier>EISSN: 1465-993X</identifier><identifier>DOI: 10.1186/s12931-024-03023-6</identifier><identifier>PMID: 39538263</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Care and treatment ; Catheters ; Catheters, Indwelling - adverse effects ; Comparative analysis ; Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Ontario - epidemiology ; Palliative Medicine ; Patient outcomes ; Pleural Effusion, Malignant - mortality ; Pleural Effusion, Malignant - therapy ; Pleural effusions ; Pleural Neoplasms ; Pleurodesis ; Pleurodesis - methods ; Population Surveillance - methods ; Retrospective Studies ; Survival ; Treatment Outcome</subject><ispartof>Respiratory research, 2024-11, Vol.25 (1), p.409-11, Article 409</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c417t-f00376148f507e929a4a9d083f4644b31788cf091443e4d0305d7c6cc7525c233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562646/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562646/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,37013,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39538263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kwok, Chanel</creatorcontrib><creatorcontrib>Thavorn, Kednapa</creatorcontrib><creatorcontrib>Amjadi, Kayvan</creatorcontrib><creatorcontrib>Aaron, Shawn D</creatorcontrib><creatorcontrib>Kendzerska, Tetyana</creatorcontrib><title>Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study</title><title>Respiratory research</title><addtitle>Respir Res</addtitle><description>Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting.
We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs.
We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline.
We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48-457] days vs. 81[IQR:29-256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95-1.69). 35% of IPCs were removed prior to death or end of follow-up.
After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Care and treatment</subject><subject>Catheters</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Comparative analysis</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Ontario - epidemiology</subject><subject>Palliative Medicine</subject><subject>Patient outcomes</subject><subject>Pleural Effusion, Malignant - mortality</subject><subject>Pleural Effusion, Malignant - therapy</subject><subject>Pleural effusions</subject><subject>Pleural Neoplasms</subject><subject>Pleurodesis</subject><subject>Pleurodesis - methods</subject><subject>Population Surveillance - methods</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Treatment Outcome</subject><issn>1465-993X</issn><issn>1465-9921</issn><issn>1465-993X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNptkk1v1DAQhiMEoqXwBzggS1y4pPg7MRdUVdBWKuICEjdr1h-7rpJ4sZ1W-y_4yXh3y6orIUux43nnyczkbZq3BJ8T0suPmVDFSIspbzHDlLXyWXNKuBStUuzX8yfnk-ZVzncYk67vxMvmhCnBeirZafPnW0wFhlA2CHxxCZXkoIxuKih6NNbIcoL6sh7cnGBAzvs5hzhl9BDKCoXJPrhhCNPyoDBQVq6SMrqvjzkjs3JjMDWyU0TrcsifEKB1XM8DlAprF5CdRbnMdvO6eeFhyO7N437W_Pz65cfldXv7_erm8uK2NZx0pfUYs04S3nuBO6eoAg7K4p55LjlfsNppbzxWhHPmuK3zEbYz0phOUGEoY2fNzZ5rI9zpdQojpI2OEPTuIqalhlSCGZwmDvsOpPBWYY6dA6jfVkCZJL3iHlfW5z1rPS9GZ02dXp3EEfQ4MoWVXsZ7TYiQVHJZCR8eCSn-nl0uegzZ1MnC5OKcNSO07ynuiKjS93vpEmptYfKxIs1Wri96IpQSXGxLOv-Pqi67_Rlxcj7U-6MEuk8wKeacnD-UT7De2k3v7aar3fTObnpb9runjR9S_vmL_QVWr9LF</recordid><startdate>20241113</startdate><enddate>20241113</enddate><creator>Kwok, Chanel</creator><creator>Thavorn, Kednapa</creator><creator>Amjadi, Kayvan</creator><creator>Aaron, Shawn D</creator><creator>Kendzerska, Tetyana</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20241113</creationdate><title>Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study</title><author>Kwok, Chanel ; Thavorn, Kednapa ; Amjadi, Kayvan ; Aaron, Shawn D ; Kendzerska, Tetyana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-f00376148f507e929a4a9d083f4644b31788cf091443e4d0305d7c6cc7525c233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Care and treatment</topic><topic>Catheters</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Comparative analysis</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ontario - epidemiology</topic><topic>Palliative Medicine</topic><topic>Patient outcomes</topic><topic>Pleural Effusion, Malignant - mortality</topic><topic>Pleural Effusion, Malignant - therapy</topic><topic>Pleural effusions</topic><topic>Pleural Neoplasms</topic><topic>Pleurodesis</topic><topic>Pleurodesis - methods</topic><topic>Population Surveillance - methods</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kwok, Chanel</creatorcontrib><creatorcontrib>Thavorn, Kednapa</creatorcontrib><creatorcontrib>Amjadi, Kayvan</creatorcontrib><creatorcontrib>Aaron, Shawn D</creatorcontrib><creatorcontrib>Kendzerska, Tetyana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Respiratory research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kwok, Chanel</au><au>Thavorn, Kednapa</au><au>Amjadi, Kayvan</au><au>Aaron, Shawn D</au><au>Kendzerska, Tetyana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study</atitle><jtitle>Respiratory research</jtitle><addtitle>Respir Res</addtitle><date>2024-11-13</date><risdate>2024</risdate><volume>25</volume><issue>1</issue><spage>409</spage><epage>11</epage><pages>409-11</pages><artnum>409</artnum><issn>1465-993X</issn><issn>1465-9921</issn><eissn>1465-993X</eissn><abstract>Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting.
We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs.
We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline.
We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48-457] days vs. 81[IQR:29-256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95-1.69). 35% of IPCs were removed prior to death or end of follow-up.
After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>39538263</pmid><doi>10.1186/s12931-024-03023-6</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Care and treatment Catheters Catheters, Indwelling - adverse effects Comparative analysis Diagnosis Female Humans Male Middle Aged Ontario - epidemiology Palliative Medicine Patient outcomes Pleural Effusion, Malignant - mortality Pleural Effusion, Malignant - therapy Pleural effusions Pleural Neoplasms Pleurodesis Pleurodesis - methods Population Surveillance - methods Retrospective Studies Survival Treatment Outcome |
| title | Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study |
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