Malignant Pleural Effusion, Pleural Effusion
Conditions
Keywords
Pleural malignancy, pleural effusion, pleurodesis, chest tube, cancer, cancer pain management
Brief summary
Fluid caused by cancer cells may accumulate in the lining of the lung. Draining the fluid with a chest tube may relieve pain and shortness of breath. To stop the fluid from coming back again, patients are given a medicine (talc) into the chest drain to seal up the space around the lung. This procedure is known as pleurodesis. This sometimes causes pain and discomfort, and the investigators do not know the best way of preventing this. The investigators hope to find the best way to prevent pain during pleurodesis.
Detailed description
Patients with metastatic cancer often have fluid collecting around the lung as a result of cancer cells spreading to the membranes adjacent to the lung (malignant pleural effusion). The standard way of treating this condition, which may cause unpleasant symptoms such as breathlessness and cough, is to drain the fluid off and then seal the cavity, using a drug (talc) given into the chest drain. Talc causes inflammation in the lining of the lung and chest wall, sticking the two surfaces together and preventing fluid from recurring. This procedure is often very painful; the pain may be partly related to the size of the chest tube used and the type of analgesia taken by the patient during the procedure. Reducing the amount of pain associated with this procedure would be a substantial benefit for patients undergoing this procedure. This trial is looking at which of two different drug regimens is more effective in preventing pleurodesis pain, and whether the size of chest tube influences pain. It will also address whether either of these influences success rate of pleurodesis. We hope to learn whether the size of chest drain or the type of pain medication given (ibuprofen or morphine) influences the amount of pain felt after the pleurodesis procedure. We hope to find the best way of preventing pain during this procedure.
Interventions
OTHERLarge bore chest drain + NSAID based analgesic regimen
Chest tube greater than 14 French size and ibuprofen.
OTHERSmall bore chest drain + NSAID based analgesic regimen
Chest tube less than or equal to 14 French size and ibuprofen.
OTHERLarge bore chest drain + opiate based analgesic regimen
Chest tube greater than 14 French size and morphine.
OTHERSmall bore chest drain + opiate based analgesic regimen
Chest tube less than or equal to 14 French size and morphine.
Sponsors
University of California, Davis
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Clinically confident diagnosis of malignant pleural effusion requiring pleurodesis. The diagnosis may be established by one of: * Histologically proven pleural malignancy OR * Typical features of pleural malignancy seen on direct vision during thoracoscopy OR * Pleural effusion in the context of histologically proven cancer elsewhere 2. Expected survival more than 1 month 3. Written informed consent
Exclusion criteria
1. Age \< 18 years 2. Primary lymphoma or small cell lung carcinoma 3. Patients who are pregnant or lactating 4. Inability to give informed consent 5. History of GI bleeding or of untreated peptic ulceration 6. Known sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs)/opiates/acetaminophen 7. Hypercapnic respiratory failure 8. Known intravenous drug abuse 9. Severe renal or liver disease 10. Known bleeding diathesis 11. Warfarin therapy 12. Current or recent (within 2 weeks) corticosteroid steroid therapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| An average pain score over 72 hours post pleurodesis for malignant pleural effusion | 72 hours |
| Pleurodesis success at 3 months post randomization (time to relapse of pleural effusion) | 3 months |
Secondary
| Measure | Time frame |
|---|---|
| Presence of chronic chest pain on the side of the pleurodesis | 6 weeks |
Countries
United States
Outcome results
None listed