Current approaches in the treatment of malignant ascites in Germany and Austria.

Abstract

e20670 Background: Malignant Ascites (MA) is a common manifestation of advanced cancer associated with a poor prognosis and decreased quality of life. Currently there are no evidence based guidelines for the management of MA and only one agent is approved for its treatment. We conducted a survey with physicians throughout Germany and Austria, to get an overview of current approaches and opinions in the treatment of MA. Methods: 128 medical oncologists (MO), gastroenterologists (GE) and gynecologists (GYN) completed an electronic questionnaire consisting of 33 questions. Answers were evaluated with descriptive statistics. Results: 90% of the physicians were from Germany, 10% from Austria. 48% of those were MO, 30% were GYN and 14% were GE. Most physicians treated an average of 34 pts/year with MA. 26% of these pts suffered from ovarian, 20% from pancreatic, 17% from gastric and 14% from colorectal cancer. The majority of the physicians associated MA with poor prognosis (92%) and significant reduction in quality of life (87%). One third felt MA was a contraindication for full dosing of systemic chemotherapy. Paracentesis (P) was performed in 70% of pts with with symptom relieve and quality of life being the main reasons. Almost half of the pts required 3-5 P, 50% even more than 5 P during the course of their disease. Only 15% of pts needed multiple P per week, the majority (79%) needed the procedure either once a week or every 14 days. In 61% of pts 3-5 l ascites fluid was drained. Only in 8%, 5 l and more were removed. Volume substitution with IV albumin was performed in 40% of pts. Most pts (55%) had to stay 1-3h in a healthcare facility for the procedure. However 21% had to stay > 1 day. While almost all physicians (89%) performed a P at some point in the treatment of MA, 75% felt that a systemic chemotherapy and 55% thought a concomitant diuretic therapy were a necessary adjunct. 7% of the pts received a targeted treatment with catumaxomab. Conclusions: Even though repeated P is the main pillar of treatment of MA, its effect is only temporary, must be performed multiple times, requiring hospital resources. Further treatment strategies have to be evaluated in prospective studies. Targeted therapies like catumaxomab should be integrated into these.