Pleural effusions are a big problem if you have mesothelioma. Pleural effusion is the medical term for excess fluid in the space between the inner and outer linings of your lungs.
Mesothelioma causes this excess fluid. The excess fluid is bad because it makes it harder for you to breathe. It also adds to your discomfort.
Pleural effusions are treated by draining the fluid and then taking one or more steps to prevent it from coming back. The traditional way of doing this is with a pleurodesis procedure.
Pleurodesis involves draining the fluid and then shrinking the space between the two linings. It’s a complicated and expensive procedure that requires hospitalization.
There is a newer way of dealing with pleural effusions. It is the indwelling pleural catheter — IPC, for short.
It’s actually pretty simple. A silicone tube is semipermanently inserted through your skin into the pleural space. The fluid drains out through the tube. It keeps draining as the fluid tries to build back up.
A lot of mesothelioma specialists favor IPCs. One reason is that their simplicity spares patients the need to have the insertion procedure done in a hospital. That helps make an IPC less expensive than a pleurodesis.
Another reason to like IPCs is that most mesothelioma patients are good candidates to receive one. With a pleurodesis procedure, you’re only a good candidate if your lungs are fully expanded.
However, mesothelioma specialists who advocate using IPCs are locked in a dispute over the question of how best to use them.
IPC: The Aggressive Approach
Researchers from Australia, Malaysia, China, the United States and the United Kingdom got together recently to consider this dispute and to initiate a plan to put the matter to rest.
In an article they wrote for an online issue of BMJ Open, the researchers explained that the disagreement revolves around two rival approaches to draining with an IPC.
The first approach calls for draining fluids once a day (or every other day) even if the patient has no effusion symptoms.
This is labeled the “aggressive” approach. It’s the one used by many cancer centers in the U.S. and Canada.
Those who prefer this approach say it ensures maximum control of symptoms. Maximum control of symptoms allows patients to be more physically active and have a better quality of life, they argue.
Symptom control is possible with this approach because it keeps the space between the inner and outer lining of the lungs dry.
The dryness also promotes the closing of that space. This is good because it prevents the fluid from building up in the first place.
IPC: The Symptom-Guided Approach
The second approach is used mainly by cancer centers in the U.K. and elsewhere. It calls for draining fluids once a week or possibly just once a month. How often it’s actually done depends on the patient’s effusion symptoms.
The advocates of “symptom-guided drainage” say that there’s no need to drain daily because it doesn’t accomplish much if the patient can already breathe comfortably. It’s a waste of time — and time is money.
To settle this debate, the researchers are preparing to conduct an investigation at a number of cancer centers with the help of 86 patients who have pleural effusions caused by mesothelioma or some other cancer.
The study is called the Australian Malignant Pleural Effusion Trial-2. They refer to it by its acronym, AMPLE.
All 86 patients will receive an IPC. Some will be treated with only the daily drainage approach. Others will be treated with only the symptom-guided drainage approach.
The results should be interesting and — ideally — will end the dispute. But findings won’t be made known for some time yet because the study is just getting underway.
