Effects of cell-free and concentrated ascites reinfusion therapy (CART) on symptom relief of malignancy-related ascites.

Abstract

It is expected that cell-free and concentrated ascites reinfusion therapy (CART) will relieve the symptoms caused by ascites. To date, however, no report of objective changes in patients' symptoms has been published. We have therefore evaluated symptom management by CART. From April 2011 to July 2012, 37 patients at our hospital, most of whom had malignancies, received CART. Symptom severity was evaluated in each patient 24 h before and after the first CART procedure using a numerical rating scale for abdominal tension and the Japanese version of the M. D. Anderson Symptom Inventory (MDASI-J) for various symptoms. CART significantly improved the scores for abdominal tension and the symptom and interference scores of the MDASI-J within 24 h of the procedure. The abdominal tension scores decreased from 7.19 to 3.81 (p < 0.001), the symptom scores of the MDASI-J decreased from 4.73 to 2.75 and the interference scores of the MDASI-J decreased from 7.05 to 5.12. Detailed investigation revealed many symptoms, including fatigue and gastric symptoms, which are the usual targets of paracentesis, as well as general symptoms. No significant correlation between improved scores and the amount of reinfused protein or ascites removed was observed. Patients experienced no severe adverse event. Among the 37 patients receiving CART, various symptoms related to malignant ascites, especially fatigue, improved within the 24-h period following CART. Factors that ameliorate these symptoms remain to be elucidated.