Malignant pleural effusion in palliative care
Pleural effusions can commonly develop in patients with advanced cancer, with lung cancer being the most common cause.
Although many malignant pleural effusions begin asymptomatically, most worsen and cause breathlessness. Unless diagnostic information is required, do not perform thoracocentesis for asymptomatic effusions.
Management of malignant pleural effusion in palliative care is guided by the degree of breathlessness, potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.
For patients with palliative care needs who have breathlessness caused by a new effusion, consider thoracocentesis under ultrasound, which is a bedside procedure that provides diagnostic information and assessment of symptomatic response to complete drainage. Repeated thoracocentesis without definitive management is not recommended because it is associated with poor quality of lifeFeller-Kopman, 2018Mallow, 2018. If a subsequent symptomatic effusion develops, seek specialist respiratory, thoracic surgery and oncology advice on definitive management, which may involve ward-based or surgical pleurodesis1, or placement of an indwelling tunnelled pleural catheter for drainage.
For patients who are not well enough, or who choose not to receive thoracocentesis or definitive management, provide symptomatic management of breathlessness—see Breathlessness in palliative care. Also see Principles of care in the last days of life for management of symptoms in the last days of life.