DEVELOPMENT OF A MALIGNANT PLEURAL EFFUSION CLINIC WITHIN A CANCER CENTER

Abstract

TOPIC: Practice Management and Administration TYPE: Original Investigations PURPOSE: In response to patient and medical oncologist concerns that malignant pleural effusion (MPE) needs were not easily met, a clinic dedicated to MPE was developed within a healthcare system’s cancer institute. We examined the impact of this clinic, which continued during the COVID-19 pandemic at a time when home health services were less available. Secondary objectives include comparing outcomes of patients undergoing medical pleuroscopy versus direct indwelling pleural catheter (IPC) placement. METHODS: Sequential cases were reviewed in a newly developed clinic, staffed by a pulmonologist (JS) and Advanced Practice APP (CS), dedicated to patients with MPE from January 2019 through December 2020. Data collected included primary histological type, interventions required, common complications, and duration of need for IPC. RESULTS: 75 patients were evaluated in the first 24-month period since the clinic began. Malignancies associated with MPE were Lung (30), Breast (13), Gynecological (12), and Hematological (9). Of the 80 IPCs placed, 53 were placed by an interventional radiologist (IR) and 27 by pulmonologist via medical pleuroscopy. The average number of days required for an IPC were 42.5 days after pleuroscopy and 79.6 days after direct placement. Of the 75 patients, 25 received talc pleurodesis and 27 received fibrinolytic therapies. Pleuroscopy had 8 non-life-threatening complications consisting of small pneumothorax (7) or increased pain (1) and required 7.2 average follow up visits. IR placement had 12 non-threatening complications consisting of bleeding (2), infection (2), or small pneumothorax (8) and required 4.1 average follow up visits. Notably, 15 patients had pleural effusions with trapped lung physiology prior to IPC placement. CONCLUSIONS: We have demonstrated that a clinic dedicated to patients with MPE's is viable and provides clinical value, including the ability to facilitate patient care during the COVID-19 pandemic. Prior to the clinic’s establishment, patients seen in the general pulmonary setting were unable to undergo pleurodesis nor intrapleural thrombolytics, emphasizing the importance of subspeciality clinics, as they are able to address important gaps in patient care. Consistent with previously published studies, a substantial number of MPE’s were from cancers other than lung. Importantly, many patients exhibited trapped lung at time of intervention, indicating the need to detect patients and intervene earlier in the pleural effusion process. Medical pleuroscopy seemed to offer reduction in IPC duration when compared to directed IPC placement. Despite limitations in our study, we aim to expand the scope of the MPE clinic. CLINICAL IMPLICATIONS: Many patients with MPE have unmet clinical needs, which were exacerbated during the pandemic with home health shortages. Having a pulmonary-driven presence within a cancer institute facilitated the care of these patients. This study affrims that general pulmonary clinics may be missing an important opportunity to care for patients with MPE and would benefit from creating services to manage these patients. Furthermore, medical pleuroscopy may reduce IPC duration, thus lowering costs and healthcare utilization. DISCLOSURES: No relevant relationships by Stephen Mitchell, source=Web Response Speaker/Speaker's Bureau relationship with Astra Zeneca Please note: Jan 2020- Oct 2020 Added 05/11/2021 by Cindy Sing, source=Web Response, value=Honoraria Advisory Committee Member relationship with Somnoware Sleep Solutions Please note: $1001 - $5000 Added 12/01/2020 by Jaspal Singh, source=Web Response, value=Consulting fee no disclosure on file for Michael Zgoda