Abstract
Background: Malignant pleural effusion (MPE) is a major problem in patients with advanced cancer. Pleural approximation is necessary for a successful pleurodesis. The decision to perform a pleurodesis is made by the pulmonologist. Inter-physician variances in the assessment of the Chest X-ray might have impact on the final outcome of the pleurodesis procedure.
Aims and objectives: To describe decision variability among physicians regarding pleurodesis.
Methods: A series of 50 consecutive chest X-rays made during MPE drainage with clinical data were sent to all active Dutch pulmonologists, together with a questionnaire on the MPE management. The following questions were asked for all of these X-rays: (1) Do you report this lung to be expanded? (2) Would you install a sclerotic agent?; (3) What would be the estimated chance on a successful pleurodesis?
Results: Pulmonologists of 30% of the Dutch hospitals responded. All pulmonologists were aware of the national guideline. The overall probability of recommending a pleurodesis was higher in the expanded lung group than in the not expanded lungs (90 vs 39%; p<0.0001). More experienced pulmonologists (more vs. ≤ 100 drains per year) less often reported a fully expanded lung (49 vs 57%; p=0.03), but were likely to recommend pleurodesis more often (probability was 95 vs 85% patients with a fully expanded lung and 44 vs 32% for an incomplete expanded lung; p=0.06). All pulmonologists assessed the success rate for breast cancer higher than for other tumors (p=0.002), and they tended to recommend pleurodesis more often in this group (p=0.07).
Conclusion: Pulmonologists's experience influences decisions regarding MPE management.
- © 2011 ERS