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Mishra EK, Stanton A. Patient-Reported Outcomes in Pleural Effusions: A Systematic Review. Cureus 2024; 16:e52430. [PMID: 38371010 PMCID: PMC10870697 DOI: 10.7759/cureus.52430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Pleural effusions cause breathlessness, decreased activity levels, and impaired quality of life. Clinical trials of drainage of pleural effusion use patient-reported outcome measures (PROMs) to assess these variables. This systematic review aimed to identify which PROMs have been used in clinical trials in pleural effusions, what variables were assessed, whether they were responsive to pleural interventions, and whether they have been validated in patients with pleural effusions, including a defined minimal clinically important difference (MCID). A systematic review was performed to identify relevant clinical trials from Medline, EMBASE, Emcare, and CINAHL and data were extracted. From 329 abstracts, 29 clinical trials of pleural effusion drainage that used PROMs as an outcome measure were identified. A total of 16 different PROMs were used. The most used PROMs were unidimensional measurements of breathlessness, particularly the visual analogue scale for dyspnoea (VASD), all of which nearly showed improvements in breathlessness following pleural fluid drainage. Other variables commonly assessed included activity levels and health-related quality of life. Multidimensional PROMs showed inconsistent responsiveness to pleural fluid drainage. Only the VASD was validated in this patient group with a defined MCID. A range of PROMs are used in clinical trials of pleural fluid drainage. No single PROM measures all the outcomes of interest. Unidimensional measurements of breathlessness are responsive to pleural fluid drainage. Only the VASD is validated with an MCID. There is a need for properly validated, response PROMs which measure the key outcomes of interest in this patient group.
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Affiliation(s)
- Eleanor K Mishra
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, GBR
| | - Andrew Stanton
- Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, GBR
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2
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Twose C, Ferris R, Wilson A, Rahman N, Farquhar M, Mishra E. Therapeutic thoracentesis symptoms and activity: a qualitative study. BMJ Support Palliat Care 2023; 13:e190-e196. [PMID: 33419856 DOI: 10.1136/bmjspcare-2020-002584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Malignant pleural effusions (MPEs) commonly occur in patients with advanced cancer. Drainage of fluid is used to relieve symptoms and improve quality of life. OBJECTIVE To improve our understanding of how therapeutic aspiration affects symptoms and activities in patients with MPE. METHODS Patients presenting to the Pleural Clinic at Norfolk and Norwich University Hospital with a confirmed or suspected MPE participated in up to three semistructured interviews during their diagnostic/therapeutic pathway. Interviews were analysed using framework analysis by two researchers independently. RESULTS Sixteen patients participated. Symptoms reported before drainage included breathlessness, cough, chest pain, fatigue and anorexia. Symptoms affected their activities, including walking, bending over and socialisation. Patients described anxiety about the underlying diagnosis and fear of over-reliance on others. Expectations of drainage outcome varied, with some hoping for a cure and others hoping for any improvement. After drainage, breathlessness, chest pain and cough improved in some patients. They reported feeling and sleeping better, but fatigue and poor appetite remained. Participants were more active after aspiration, but the duration of improvement was a few days only. Despite this, patients still felt the procedure worthwhile. CONCLUSION Overall health and respiratory symptoms improved following drainage, but constitutional symptoms did not improve. This may be because constitutional symptoms are caused by the underlying cancer. This study suggests that clinicians should consider a range of symptoms, rather than just breathlessness, in planning outcomes for clinical trials. These results are important to inform patients about the potential benefits and duration of symptom improvement after therapeutic aspiration.
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Affiliation(s)
- Chloe Twose
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Rebecca Ferris
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Andrew Wilson
- School of Medicine, University of East Anglia, Norwich, UK
| | - Najib Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eleanor Mishra
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK
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Lopez P, Fitzgerald DB, McVeigh JA, Badiei A, Muruganandan S, Newton RU, Straker L, Lee YCG, Peddle-McIntyre CJ. Associations of physical activity and quality of life in parapneumonic effusion patients. ERJ Open Res 2023; 9:00209-2023. [PMID: 37753285 PMCID: PMC10518875 DOI: 10.1183/23120541.00209-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Little is known about activity behaviours and quality of life (QoL) of patients with parapneumonic pleural effusions (PPE) after hospital discharge. This study is a secondary analysis of a randomised trial (dexamethasone versus placebo) for hospitalised patients with PPE. We: 1) described the patients' activity behaviour patterns and QoL measured at discharge and at 30 days post-discharge; and 2) examined the association between activity behaviours and QoL scores. Methods Activity behaviour (7-day accelerometry; Actigraph GT3X+) and QoL (Medical Outcomes Study Short-Form 36) were assessed. Repeated measures analysis of covariance controlling for baseline values and a series of linear regression models were undertaken. Results 36 out of 53 eligible participants completed accelerometry assessments. Despite modest increases in light physical activity (+7.5%) and some domains of QoL (>2 points) from discharge to 30 days post-discharge, patients had persistently high levels of sedentary behaviour (>65% of waking wear time) and poor QoL (≤50 out of 100 points) irrespective of treatment group (p=0.135-0.903). Increasing moderate-to-vigorous physical activity was associated with higher scores on most QoL domains (p=0.006-0.037). Linear regression indicates that a clinically important difference of 5 points in physical composite QoL score can be achieved by reallocating 16.1 min·day-1 of sedentary time to moderate-to-vigorous physical activity. Conclusion Patients with PPE had low levels of physical activity and QoL at discharge and 30 days post-discharge irrespective of treatment. Moderate-to-vigorous physical activity participation was associated with higher QoL scores. Increasing moderate-to-vigorous physical activity following discharge from the hospital may be associated with improvements in QoL.
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Affiliation(s)
- Pedro Lopez
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Joint first authors
| | - Deirdre B. Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
- Joint first authors
| | - Joanne A. McVeigh
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Arash Badiei
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | | | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Yun Chor Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
- Joint senior authors
| | - Carolyn J. Peddle-McIntyre
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Joint senior authors
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4
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Kos M, Brouwer CG, van Laarhoven HW, Hopman MT, van Oijen MG, Buffart LM. The association between wearable device metrics and clinical outcomes in oncology: a systematic review with evidence synthesis and meta-analysis. Crit Rev Oncol Hematol 2023; 185:103979. [PMID: 37001837 DOI: 10.1016/j.critrevonc.2023.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The emerging study of wearable devices (WDs) in patients with cancer provides opportunities to harness real-time patient data for predicting clinical outcomes. We conducted a systematic review with best evidence synthesis to examine the association between WD metrics and clinical outcomes in patients with cancer. METHODS MEDLINE and Embase were searched from inception until June 2022. Risk of bias assessment and best evidence synthesis were performed and, If possible, meta-analysis was conducted. RESULTS A total of 34 studies was included. We found moderate-to-strong evidence for associations between circadian rest-activity metrics and OS. Disrupted I<O was associated with increased hazard for death (HR 2.08; 95 %CI: 1.50-2.88). For most associations there was insufficient evidence due to lack of studies (n = 32) or inconsistent results (n = 14). CONCLUSION Meta-analysis was greatly hampered due to heterogeneity and different methodology used between studies. Studies primarily designed to investigate the association between WD metrics and clinical outcomes are warranted.
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Peddle-McIntyre CJ, Muruganandan S, McVeigh J, Fitzgerald DB, Straker L, Newton RU, Murray K, Lee YCG. Device assessed activity behaviours in patients with indwelling pleural catheter: A sub-study of the Australasian Malignant PLeural Effusion (AMPLE)-2 randomized trial. Respirology 2023; 28:561-570. [PMID: 36642702 DOI: 10.1111/resp.14451] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Device-assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)-2 was a multi-centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom-guided (SGD) drainage for 60-days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL). METHODS Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5-months. Activity behaviour outcomes were calculated as percent of daily waking-wear time and compared between groups (Mann-Whitney U test; Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined. RESULTS Forty-one (91%) participants provided ≥1 valid accelerometry assessment (DDn = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%-74% across timepoints), and very little time in moderate-to-vigorous physical activity (<1% across timepoints). Compared to SGD group, DD group had a more favourable sedentary-to-light ratio in the week following randomization (2.4 [2.0-3.4] vs. 3.2 [2.4-6.1]; p = 0.047) and at 60-days (2.0 [1.9-2.9] vs. 2.9 [2.8-6.0]; p = 0.016). Sedentary-to-light ratio was correlated with multiple QoL domains at multiple timepoints. CONCLUSION Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations.
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Affiliation(s)
- Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne McVeigh
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia.,Movement Physiology Laboratory, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Deirdre B Fitzgerald
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Institute for Respiratory Health & Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Leon Straker
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Yun Chor Gary Lee
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Institute for Respiratory Health & Medical School, University of Western Australia, Nedlands, Western Australia, Australia
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Fitzgerald DB, Sidhu C, Budgeon C, Tan AL, Read CA, Kwan BCH, Smith NA, Fysh ET, Muruganandan S, Saghaie T, Shrestha R, Badiei A, Nguyen P, Burke A, Goddard J, Windsor M, McDonald J, Wright G, Czarnecka K, Sivakumar P, Yasufuku K, Feller-Kopman DJ, Maskell NA, Murray K, Lee YCG. Australasian Malignant PLeural Effusion (AMPLE)-3 trial: study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion. Trials 2022; 23:530. [PMID: 35761341 PMCID: PMC9235203 DOI: 10.1186/s13063-022-06405-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. Methods and analysis A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Ethics and dissemination Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Discussion Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12618001013257. Registered on 18 June 2018. Protocol version: Version 3.00/4.02.19 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06405-7.
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Affiliation(s)
- Deirdre B Fitzgerald
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Calvin Sidhu
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Charley Budgeon
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Ai Ling Tan
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Catherine A Read
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Benjamin C H Kwan
- Department of Respiratory and Sleep Medicine, The Sutherland Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Nicola Ann Smith
- Respiratory Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Edward T Fysh
- Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, Australia.,Respiratory Medicine, St John of God Hospital Midland, Midland, WA, Australia
| | | | - Tajalli Saghaie
- Respiratory Medicine, Concord Repatriation General Hospital, Concord West, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ranjan Shrestha
- Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Arash Badiei
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
| | - Phan Nguyen
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
| | - Andrew Burke
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - John Goddard
- Respiratory Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia.,Griffith University, Brisbane, QLD, Australia
| | - Morgan Windsor
- Thoracic Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Julie McDonald
- Respiratory and Sleep Medicine Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery & University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Kasia Czarnecka
- Division of Thoracic Surgery, Toronto General Hospital University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Y C Gary Lee
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. .,Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, Australia. .,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.
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7
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Uncovering Objective Improvements in Physical Activity Using Digital Actigraphy after Therapeutic Thoracentesis: A Pilot Study. Ann Am Thorac Soc 2022; 19:1438-1440. [PMID: 35587360 DOI: 10.1513/annalsats.202202-165rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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DeBiasi EM, Feller-Kopman D. Anatomy and Applied Physiology of the Pleural Space. Clin Chest Med 2021; 42:567-576. [PMID: 34774165 DOI: 10.1016/j.ccm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The unique anatomy and physiology of the pleural space provides tight regulation of liquid within the space under normal physiologic conditions. When this balance is disrupted and pleural effusions develop, there can be significant impacts on the respiratory system. Drainage of effusions can lead to meaningful improvement in symptoms, primarily owing to improvement in the length-tension relationship of the respiratory muscles. Ultrasound examination to evaluate the movement and function of the diaphragm, as well as pleural manometry, have provided a greater understanding of the impact of pleural effusion and thoracentesis.
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Affiliation(s)
- Erin M DeBiasi
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Hassan M, Banka R, Castro-Añón O, Mercer RM, Bedawi EO, Asciak R, Stradling J, Rahman NM. Physical Activity and Sedentary Behaviour in Patients With Malignant Pleural Effusion Undergoing Therapeutic Pleural Interventions (The ASPIRE Study). Arch Bronconeumol 2021; 57:656-658. [PMID: 35699052 DOI: 10.1016/j.arbr.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/30/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt.
| | - Radhika Banka
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Olalla Castro-Añón
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Pneumology Service, Lucus Augusti University Hospital, Lugo, Spain
| | - Rachel M Mercer
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - John Stradling
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
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10
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The association between wearable activity monitor metrics and performance status in oncology: a systematic review. Support Care Cancer 2021; 29:7085-7099. [PMID: 34117567 PMCID: PMC8464563 DOI: 10.1007/s00520-021-06234-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The expanding armamentarium of wearable activity monitors (WAMs) offers new opportunities to supplement physician-assessed performance status (PS) with real-life patient activity data. These data could guide clinical decision making or serve as a measure of treatment outcome. However, information on the association between physical activity (PA) and sedentary behavior (SB) monitored with wearables (i.e., WAM metrics) and PS in patients with cancer is needed. Therefore, we conducted a systematic review to examine the association between WAM metrics and PS in patients with cancer. METHODS We searched MEDLINE and Embase for studies that assessed the association between WAM metrics and performance status among adults with cancer. We extracted information on study design and population, WAM type and different activity metrics, outcome definitions, and results. Included studies were subjected to risk of bias assessment and subsequent best evidence synthesis. RESULTS Fourteen studies were included in this review. All studies reported on different combinations of WAM metrics including: daily steps (n = 8), SB (n = 5), mean activity counts (n = 4), dichotomous circadian rest-activity index (n = 3), and time spent in moderate-to-vigorous PA (MVPA) (n = 3). Much heterogeneity was observed regarding study population, WAM used, and reporting of results. We found moderate evidence for a positive weak-to-moderate association between WAM-assessed PA and PS and a weak-to-moderate negative association between WAM-assessed SB metrics and PS. CONCLUSION Weak-to-moderate associations between WAM metrics and PS suggest that WAM data and physician-assessed PS cannot be used interchangeably. Instead, WAM data could serve as a dynamic and objective supplement measurement of patients' physical performance.
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11
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Hassan M, Banka R, Castro-Añón O, Mercer RM, Bedawi EO, Asciak R, Stradling J, Rahman NM. Physical Activity and Sedentary Behaviour in Patients With Malignant Pleural Effusion Undergoing Therapeutic Pleural Interventions (The ASPIRE Study). Arch Bronconeumol 2020; 57:S0300-2896(20)30382-3. [PMID: 33189419 DOI: 10.1016/j.arbres.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt.
| | - Radhika Banka
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Olalla Castro-Añón
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Pneumology Service, Lucus Augusti University Hospital, Lugo, Spain
| | - Rachel M Mercer
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - John Stradling
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
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Fisher SA, Peddle-McIntyre CJ, Burton K, Newton RU, Marcq E, Lake RA, Nowak AK. Voluntary exercise in mesothelioma: effects on tumour growth and treatment response in a murine model. BMC Res Notes 2020; 13:435. [PMID: 32933580 PMCID: PMC7493394 DOI: 10.1186/s13104-020-05284-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
Objective There is substantial evidence that exercise can safely reduce the risk of cancer and improve survival in different human cancer populations. Long latency periods associated with carcinogen–induced cancers like asbestos induced mesothelioma provide an opportunity to implement exercise as an intervention to delay or prevent disease development. However, there are limited studies investigating the ability of exercise to prevent or delay cancer, and exercise as a preventive strategy has never been assessed in models with a known carcinogen. We investigated the potential of voluntary exercise (VE) to delay development of asbestos related disease (ARD) in our well-characterised, asbestos induced MexTAg model of mesothelioma. Results Asbestos exposed MexTAg mice were given continuous or delayed access to VE and ARD assessed over time. We found that the addition of VE did not affect ARD development in asbestos exposed MexTAg mice. However, non–asbestos exposed, aged matched control mice participated in significantly more VE behaviours, suggesting subclinical development of ARD after asbestos exposure had a greater impact on VE participation than age alone. These data highlight the importance of model choice and the potential limitation that some pre–clinical studies may not accurately represent the clinical paradigm, particularly in the context of prevention studies.
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Affiliation(s)
- Scott A Fisher
- National Centre for Asbestos Related Diseases (NCARD), Perth, Australia. .,School of Biomedical Sciences, University of Western Australia, Perth, Australia.
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Kimberley Burton
- National Centre for Asbestos Related Diseases (NCARD), Perth, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Elly Marcq
- Centre for Oncological Research, University of Antwerp, Antwerp, Belgium
| | - Richard A Lake
- National Centre for Asbestos Related Diseases (NCARD), Perth, Australia
| | - Anna K Nowak
- National Centre for Asbestos Related Diseases (NCARD), Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
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13
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Thomas R, Rahman NM, Maskell NA, Lee YCG. Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps. Respirology 2020; 25:963-971. [PMID: 32613624 DOI: 10.1111/resp.13881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
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Affiliation(s)
- Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.,Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, WA, Australia
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14
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Sliepen M, Lipperts M, Tjur M, Mechlenburg I. Use of accelerometer-based activity monitoring in orthopaedics: benefits, impact and practical considerations. EFORT Open Rev 2020; 4:678-685. [PMID: 32010456 PMCID: PMC6986392 DOI: 10.1302/2058-5241.4.180041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Studies of the effectiveness of orthopaedic interventions do not generally measure physical activity (PA). Applying accelerometer-based activity monitoring in orthopaedic studies will add relevant information to the generally examined physical function and pain assessment.Accelerometer-based activity monitoring is practically feasible in orthopaedic patient populations, since current day activity sensors have battery time and memory to measure continuously for several weeks without requiring technical expertise.The ongoing development in sensor technology has made it possible to combine functional tests with activity monitoring.For clinicians, the application of accelerometer-based activity monitoring can provide a measure of PA and can be used for clinical comparisons before and after interventions.In orthopaedic rehabilitation, accelerometer-based activity monitoring may be used to help patients reach their targets for PA and to coach patients towards a more active lifestyle through direct feedback. Cite this article: EFORT Open Rev 2019;4:678-685. DOI: 10.1302/2058-5241.4.180041.
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Affiliation(s)
- Maik Sliepen
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Germany
| | - Matthijs Lipperts
- AHORSE, Department of Orthopaedics, Zuyderland Medical Centre, The Netherlands
| | - Marianne Tjur
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
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15
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Peddle-McIntyre CJ, Cavalheri V, Boyle T, McVeigh JA, Jeffery E, Lynch BM, Vallance JK. A Review of Accelerometer-based Activity Monitoring in Cancer Survivorship Research. Med Sci Sports Exerc 2019; 50:1790-1801. [PMID: 29683922 DOI: 10.1249/mss.0000000000001644] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. PURPOSE To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. METHODS An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). RESULTS A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non-wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60%, and 8% of studies, respectively. Most studies reported moderate and vigorous physical activity (78%), 50% reported sedentary time, and 43% reported light-intensity activity. Cut points to categorize these activities varied between studies. CONCLUSIONS This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviors across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximize the scientific validity of future accelerometer research in this field.
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Affiliation(s)
- Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Perth, AUSTRALIA.,School of Medical and Health Sciences, Edith Cowan University, Perth, AUSTRALIA
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Curtin University, Perth, AUSTRALIA.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, AUSTRALIA
| | - Terry Boyle
- School of Public Health, Curtin University, Perth, AUSTRALIA.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, AUSTRALIA
| | - Joanne A McVeigh
- School of Occupational Therapy, Social Work & Speech Pathology, Curtin University, Perth, AUSTRALIA.,Exercise Laboratory, School of Physiology, University of Witwatersrand, SOUTH AFRICA
| | - Emily Jeffery
- Exercise Medicine Research Institute, Edith Cowan University, Perth, AUSTRALIA.,School of Medical and Health Sciences, Edith Cowan University, Perth, AUSTRALIA
| | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, AUSTRALIA.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, AUSTRALIA.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, AUSTRALIA
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, CANADA
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16
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Activity Behaviors and Physiological Characteristics of Women With Advanced-Stage Ovarian Cancer: A Preliminary Cross-sectional Investigation. Int J Gynecol Cancer 2019; 28:604-613. [PMID: 29369120 DOI: 10.1097/igc.0000000000001197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Ovarian cancer (OC) survivors experience many disease and treatment adverse effects. However, the impact of OC and its treatment on objective activity behaviors and physiological status have not been examined. The purpose of this study was to compare objectively measured activity behaviors and physiological characteristics of advanced-stage OC survivors to age-matched controls. METHODS Twenty stage III-IV OC survivors and 20 controls completed assessments of activity behaviors (7-day accelerometry), physical function (400-meter walk as indicator of cardiorespiratory fitness, repeated chair rise, 6-meter walking tests), muscle strength (1-repetition maximum and handgrip), body composition (dual-energy x-ray absorptiometry), and musculoskeletal morphology (peripheral quantitative computed tomography). RESULTS Compared with controls, OC survivors spent more time/day in prolonged sedentary bouts (P = 0.039, r = 0.32), had lower cardiorespiratory fitness (P = 0.041, r = 0.33) and upper body strength (P = 0.023, r = 0.37), had higher areal bone mineral content (P = 0.047, r = 0.33) and volumetric trabecular density (P = 0.048, r = 0.31), but were not different in other measures of body composition nor in muscle morphology (P > 0.050). Only 20% (n = 4) of OC survivors accrued 150 minutes/week or greater moderate and vigorous physical activity (MVPA) time in 10-minute bouts or greater. Moderate and vigorous physical activity time/day in 10-minute bouts or greater was strongly associated with cardiorespiratory fitness (P = 0.001, ρ = -0.702) and lower extremity function (P = 0.019, ρ = -0.519) and moderately associated with muscle cross-sectional area (P = 0.035, ρ = 0.473). CONCLUSIONS Posttreatment OC survivors spent more time in prolonged sedentary bouts and had lower cardiorespiratory fitness and upper body strength compared with controls. Moderate and vigorous physical activity was associated with physical function and muscle cross-sectional area. Future studies should test the efficacy of exercise interventions to increase MVPA, reduce sedentary behavior, and increase cardiorespiratory fitness and muscle strength in OC survivors.
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17
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Koegelenberg CFN, Shaw JA, Irusen EM, Lee YCG. Contemporary best practice in the management of malignant pleural effusion. Ther Adv Respir Dis 2019; 12:1753466618785098. [PMID: 29952251 PMCID: PMC6048656 DOI: 10.1177/1753466618785098] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient's wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
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Affiliation(s)
- Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, PO Box 241, Cape Town, 8000, South Africa
| | - Jane A Shaw
- Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Elvis M Irusen
- Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Y C Gary Lee
- University of Western Australia and Sir Charles Gairdner Hospital, Perth, Australia
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18
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Fitzgerald DB, Koegelenberg CFN, Yasufuku K, Lee YCG. Surgical and non-surgical management of malignant pleural effusions. Expert Rev Respir Med 2017; 12:15-26. [PMID: 29111830 DOI: 10.1080/17476348.2018.1398085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice. Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management. Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combined Indwelling Pleural Catheter (IPC) and chemical pleurodesis therapy). Individualized management for different subgroups of MPE patients should be a long-term research goal. Studies are needed on better patient selection, and adjunct non-invasive, supportive (e.g. nutrition and exercise) therapies.
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Affiliation(s)
- Deirdre B Fitzgerald
- a School of Medicine & Pharmacology , University of Western Australia , Crawley , WA , Australia.,b Pleural Medical Unit , Institute for Respiratory Health , Nedlands , WA , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , WA , Australia
| | - Coenraad F N Koegelenberg
- d Division of Pulmonology, Department of Medicine , Stellenbosch University and Tygerberg Academic Hospital , Cape Town , South Africa
| | - Kazuhiro Yasufuku
- e Division of Thoracic Surgery , Toronto General Hospital University Health Network, University of Toronto , Toronto , ON , Canada
| | - Y C Gary Lee
- a School of Medicine & Pharmacology , University of Western Australia , Crawley , WA , Australia.,b Pleural Medical Unit , Institute for Respiratory Health , Nedlands , WA , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , WA , Australia
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