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Comment & Response
April 10, 2018

Treatment Approaches for Malignant Pleural Effusion

Author Affiliations
  • 1Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  • 2School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
  • 3School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
JAMA. 2018;319(14):1507-1508. doi:10.1001/jama.2018.1323

In Reply Dr Yagi and colleagues reiterate the importance of reducing hospitalization time in terminally ill patients with cancer and considering patients’ remaining lifespan to meaningfully interpret their total hospitalization time. In our trial, patients randomized to indwelling pleural catheter treatment spent significantly less of their total time in the trial (from procedure to death or end of 12-month follow-up) in hospital (median, 6.2% [interquartile range {IQR}, 1.1%-15.0%] vs 11.1% [IQR, 3.2%-37.0%] in the talc pleurodesis group; P = .01; Figure 2 in the article). The benefit of an indwelling pleural catheter in reducing hospitalization days is especially relevant for patients with a limited prognosis. We agree with Yagi and colleagues that, conversely, for the subset of patients with malignant pleural effusion and a longer expected survival, more aggressive attempts with pleurodesis can have theoretical advantages over long-term indwelling pleural catheter use. This will be the subject of the Australasian Malignant Pleural Effusion–3 randomized trial (in planning stage).