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Quality of life improves after palliative placement of percutaneous tunneled drainage catheter for refractory ascites in prospective study of patients with end-stage cancer

Published online by Cambridge University Press:  18 March 2019

Piera Cote Robson Open the ORCID record for Piera Cote Robson [Opens in a new window] ,
Mithat Gonen ,
Ai Ni ,
Lynn Brody ,
Karen T. Brown ,
George Getrajdman ,
Bridgette Thom ,
Nancy Kline  and
Anne Covey
Piera Cote Robson*
Affiliation:
Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
Mithat Gonen
Affiliation:
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Ai Ni
Affiliation:
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Lynn Brody
Affiliation:
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
Karen T. Brown
Affiliation:
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
George Getrajdman
Affiliation:
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
Bridgette Thom
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Anne Covey
Affiliation:
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Piera Cote Robson, M.S.N., C.N.S., N.P., Department of Radiology, 1275 York Avenue, C276, New York, NY 10065. E-mail: robsonp@mskcc.org
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Abstract

Objective

Percutaneous tunneled drainage catheter (PTDC) placement is a palliative alternative to serial paracenteses in patients with end-stage cancer and refractory ascites. The impact of PTDC on quality of life (QoL) and long-term outcomes has not been prospectively described. The objective was to evaluate changes in QoL after PTDC.

Method

Eligible adult patients with end-stage cancer undergoing PTDC placement for refractory ascites completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and McGill Quality of Life instruments before PTDC placement and at 2 to 7 days and 2 to 4 weeks after PTDC. Catheter function, complications, and laboratory values were assessed. Analysis of QoL data was evaluated with a stratified Wilcoxon signed-rank test.

Result

Fifty patients enrolled. Survey completion ranged from 65% to 100% (median 88%) across timepoints. All patients had a Tenckhoff catheter, with 98% technical success. Median survival after PTDC was 38 days (95% confidence interval = 32, 57 days). European Organization for Research and Treatment of Cancer scores showed improvement in global QoL (p = 0.03) at 1 week postprocedure (PP). Significant symptom improvement was reported for fatigue, nausea/vomiting, pain, dyspnea, insomnia, and appetite at 1 week PP and was sustained at 3 weeks PP for dyspnea (p < 0.01), insomnia (p < 0.01), and appetite loss (p = 0.03). McGill Quality of Life demonstrated overall QoL improvement at 1 (p = 0.03) and 3 weeks (p = 0.04) PP. Decline in sodium and albumin values pre- and post-PTDC slowed significantly (albumin slope –0.43 to –0.26, p = 0.055; sodium slope –2.50 to 1.31, p = 0.04). Creatinine values increased at an accelerated pace post-PTDC (0.040 to 0.21, p < 0.01). Thirty-eight catheter-related complications occurred in 24 of 45 patients (53%).

Significance of results

QoL and symptoms improved after PTDC placement for refractory ascites in patients with end-stage malignancy. Decline in sodium and albumin values slowed postplacement. This study supports the use of a PTDC for palliation of refractory ascites in cancer patients.

Keywords

Malignant ascitesQuality of lifeEnd-stage cancerPercutaneous drainage catheter
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 677 - 685
Copyright
Copyright © Cambridge University Press 2019 

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References

Aaronson, NK, Ahmedzai, S, Bergman, B, et al. (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 85(5), 365–376.Google Scholar
Ayantunde, AA and Parsons, SL (2007) Pattern and prognostic factors in patients with malignant ascites: A retrospective study. Annals of Oncology 18(5), 945–949.Google Scholar
Becker, G, Galandi, D, and Blum, HE (2006) Malignant ascites: Systematic review and guideline for treatment. European Journal of Cancer 42(5), 589–597.Google Scholar
Bohn, KA and Ray, CE Jr (2015) Repeat large-volume paracentesis versus tunneled peritoneal catheter placement for malignant ascites: A cost-minimization study. AJR American Journal of Roentgenology 205(5), 1126–1134.Google Scholar
Caldwell, J, Edriss, H, and Nugent, K (2018) Chronic peritoneal indwelling catheters for the management of malignant and nonmalignant ascites. Proceedings/Baylor University Medical Center, 31(3), 297–302.Google Scholar
Cavazzoni, E, Bugiantella, W, Graziosi, L, et al. (2013) Malignant ascites: Pathophysiology and treatment. International Journal of Clinical Oncology 18(1), 1–9.Google Scholar
Cohen, SR and Mount, BM (2000) Living with cancer: “Good” days and “bad” days--what produces them? Can the McGill quality of life questionnaire distinguish between them? Cancer 89(8), 1854–1865.Google Scholar
Cohen, SR, Mount, BM, Bruera, E, et al. (1997) Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine 11(1), 3–20.Google Scholar
Cohen, SR, Mount, BM, Tomas, JJ, et al. (1996) Existential well-being is an important determinant of quality of life. Evidence from the McGill Quality of Life Questionnaire. Cancer 77(3), 576–586.Google Scholar
Coupe, NA, Cox, K, Clark, K, et al. (2013) Outcomes of permanent peritoneal ports for the management of recurrent malignant ascites. Journal of Palliative Medicine 16(8), 938–940.Google Scholar
Courtney, A, Nemcek AA, Jr, Rosenberg, S, et al. (2008) Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. Journal of Vascular and Interventional Radiology 19(12), 1723–1731.Google Scholar
Easson, AM, Bezjak, A, Ross, S, et al. (2007) The ability of existing questionnaires to measure symptom change after paracentesis for symptomatic ascites. Annals of Surgical Oncology 14(8), 2348–2357.Google Scholar
Fayers, PM, Aaronson, NK, Bjordal, K, et al. , on behalf of the EORTC Quality of Life Group (2001) EORTC QLQ-C30 Scoring Manual. Brussels: European Organisation for Research and Treatment of Cancer.Google Scholar
Fleming, ND, Alvarez-Secord, A, Von Gruenigen, V, et al. (2009) Indwelling catheters for the management of refractory malignant ascites: A systematic literature overview and retrospective chart review. Journal of Pain Symptom Management 38(3), 341–349.Google Scholar
Hicks, AM, Chou, J, Capanu, M, et al. (2016) Pancreas adenocarcinoma: Ascites, clinical manifestations, and management implications. Clinical Colorectal Cancer 15(4), 360–368.Google Scholar
Husain, A, Bezjak, A, and Easson, A (2010) Malignant ascites symptom cluster in patients referred for paracentesis. Annals of Surgical Oncology 17(2), 461–469.Google Scholar
Jehn, CF, Kupferling, S, Oskay-Ozcelik, G, et al. (2015) A survey of treatment approaches of malignant ascites in Germany and Austria. Supportive Care in Cancer 23(7), 2073–2078.Google Scholar
Leoni, CJ, Potter, JE, Rosen, MP, et al. (2001) Classifying complications of interventional procedures: A survey of practicing radiologists. Journal of Vascular and Interventional Radiology 12(1), 55–59.Google Scholar
Lua, PL, Salek, S, Finlay, I, et al. (2005) The feasibility, reliability and validity of the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF) in palliative care population. Quality of Life Research 14(7), 1669–1681.Google Scholar
Lungren, MP, Kim, CY, Stewart, JK, et al. (2013) Tunneled peritoneal drainage catheter placement for refractory ascites: Single-center experience in 188 patients. Journal of Vascular and Interventional Radiology 24(9), 1303–1308.Google Scholar
Maleux, G, Indesteege, I, Laenen, A, et al. (2016) Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: Technical results and overall clinical outcome. Radiology and Oncology 50(2), 197–203.Google Scholar
Markman, M (2012) Palliation of symptomatic malignant ascites: An (often) unmet need. Oncology 82(6), 313–314.Google Scholar
Meier, M, Mortensen, FV, and Madsen, HH (2015) Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter. Acta Radioligica Open 4(7), 2058460115579934.Google Scholar
Monsky, WL, Yoneda, KY, MacMillan, J, et al. (2009) Peritoneal and pleural ports for management of refractory ascites and pleural effusions: Assessment of impact on patient quality of life and hospice/home nursing care. Journal of Palliative Medicine 12(9), 811–817.Google Scholar
Narayanan, G, Pezeshkmehr, A, Venkat, S, et al. (2014) Safety and efficacy of the PleurX catheter for the treatment of malignant ascites. Journal of Palliative Medicine 17(8), 906–912.Google Scholar
Qu, C, Xing, M, Ghodadra, A, et al. (2016) The impact of tunneled catheters for ascites and peritoneal carcinomatosis on patient rehospitalizations. Cardiovascular and Interventional Radiology 39(5), 711–716.Google Scholar
R Development Core Team (2013) R: A language and environment for statistical computing. Vol. 2018, Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Runyon, BA (1994) Care of patients with ascites. New England Journal of Medicine 330(5), 337–342.Google Scholar
Sangisetty, SL and Miner, TJ (2012) Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World Journal of Gastrointestinal Surgery 4(4), 87–95.Google Scholar
Solbach, P, Höner Zu Siederdissen, C, Taubert, R, et al. (2017) Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis. European Journal of Gastroenterology and Hepatology 29(5), 539–546.Google Scholar
Stukan, M (2017) Drainage of malignant ascites: Patient selection and perspectives. Cancer Management and Research 9, 115–130.Google Scholar
Tapping, CR, Ling, L, and Razack, A (2012) PleurX drain use in the management of malignant ascites: Safety, complications, long-term patency and factors predictive of success. British Journal of Radiology 85(1013), 623–628.Google Scholar
White, J and Carolan-Rees, G (2012) PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites: A NICE Medical Technology Guidance. Applied Health Economics and Health Policy 10(5), 299–308.Google Scholar
Wong, BCT, Cake, L, Kachuik, L, et al. (2015) Indwelling peritoneal catheters for managing malignancy-associated ascites. Journal of Palliative Care 31(4), 243–249.Google Scholar
Yarmohammadi, H, Brody, LA, Erinjeri, JP, et al. (2016) Therapeutic application of percutaneous peritoneovenous (Denver) shunt in treating chylous ascites in cancer patients. Journal of Vascular and Interventional Radiology 27(5), 665–673.Google Scholar