Impact of a dedicated malignant pleural effusion clinic on the management of malignant pleural effusion

Abstract

Background: Malignant pleural effusions (MPE) are common complications of advanced malignancy. The treatment of MPE is generally focused on palliation of respiratory symptoms. The main drawback of the traditional method of pleurodesis is the requirement for hospitalization. Objectives: To examine the safety, efficacy and economy of management of a dedicated MPE clinic. Methods and analysis: A retrospective cohort study was designed to compare complication rates, pleural effusion control, length of hospital stay, type of interventions, estimated hospital days saved between two three-year non-contemporary periods – before the implementation of MPE clinic and after. Results: Pre MPE clinic and MPE clinic group comprised of 115 and 161 patients respectively. The number of hospital admissions was lower in the MPE clinic period (42.4% vs 73.9%; p<0.0001) and the pleural effusion control was higher in the same group (65.2% versus 51.3%; p=0.02). The estimated hospital days saved was 1001 days over 3 years. Conclusion: A dedicated malignant pleural effusion (MPE) clinic is a strategy of malignant effusion management that reduces hospital admission days and, will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Outpatient MPE clinic is of particular importance in the setting of the health care system and the overcrowded hospitals. The ability to avoid a one week hospitalization for a palliative intervention and replace it with a simple and effective outpatient procedure should appeal to patients and administrators alike.