Change in symptoms after paracentesis for symptomatic malignant ascites

Abstract

6071 Background: Symptomatic malignant ascites is a significant problem for palliative patients with intraabdominal malignancy. Paracentesis is the most common therapeutic option. Although the main goal of paracentesis is symptom palliation, the best method of assessing symptom improvement is not known. The aim of our study was to compare existing and validated symptom and quality of life (QOL) questionnaires to assess their ability to detect a clinical improvement in symptoms after paracentesis. Methods: Patients with malignant ascites were asked to complete 4 symptom and QOL questionnaires before and 24 hours after therapeutic paracentesis. These included the Edmonton Symptom Assessment System, the Memorial Symptom Assessment Scale-SF and the EORTC Core and Pancreatic Cancer Module. Demographic data was collected, and the patient’s opinions about the questionnaires and the procedure elicited. Change scores were calculated by subtracting the baseline subscale scores from the follow-up scores. Results: 61 patients completed the baseline questionnaire and 44 completed follow-up questionnaire. Patients predominantly had ovarian (41%) and gastrointestinal cancer (25%); their ECOG performance status was 2 (26%) and 3 (49%). There was no systematic difference between respondents and non-respondents. Baseline questionnaires revealed a significant amount of baseline symptoms, with the worst scores in the symptom domains. The mean amount of fluid removed was 3.5 L (range 0.3–9.7 L); there were no complications. All questionnaires showed strong sensitivity, validity and reliability when applied to this patient population. Most patients (78%) reported that their symptoms had improved as a result of the procedure. Significant improvement was demonstrated for subscales that included the most distressing symptoms, such as abdominal bloating, anorexia, dyspnea, insomnia, fatigue, as well as overall QOL. The amount of fluid removed did not correlate with symptom improvement. Conclusions: Paracentesis provides relief of symptoms for patients with malignant ascites. The existing symptom and quality of life questionnaires are valid and sensitive to change and could be suitable for clinical trials of new interventions for paracentesis. No significant financial relationships to disclose.