Twose Chloe, Ferris Rebecca, Wilson Andrew, Rahman Najib, Farquhar Morag, Mishra Eleanor
Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, UK.
School of Medicine, University of East Anglia, Norwich, UK.
BMJ Support Palliat Care. 2023 Oct;13(e1):e190-e196. doi: 10.1136/bmjspcare-2020-002584. Epub 2021 Jan 8.
Malignant pleural effusions (MPEs) commonly occur in patients with advanced cancer. Drainage of fluid is used to relieve symptoms and improve quality of life.
To improve our understanding of how therapeutic aspiration affects symptoms and activities in patients with MPE.
Patients presenting to the Pleural Clinic at Norfolk and Norwich University Hospital with a confirmed or suspected MPE participated in up to three semistructured interviews during their diagnostic/therapeutic pathway. Interviews were analysed using framework analysis by two researchers independently.
Sixteen patients participated. Symptoms reported before drainage included breathlessness, cough, chest pain, fatigue and anorexia. Symptoms affected their activities, including walking, bending over and socialisation. Patients described anxiety about the underlying diagnosis and fear of over-reliance on others. Expectations of drainage outcome varied, with some hoping for a cure and others hoping for any improvement. After drainage, breathlessness, chest pain and cough improved in some patients. They reported feeling and sleeping better, but fatigue and poor appetite remained. Participants were more active after aspiration, but the duration of improvement was a few days only. Despite this, patients still felt the procedure worthwhile.
Overall health and respiratory symptoms improved following drainage, but constitutional symptoms did not improve. This may be because constitutional symptoms are caused by the underlying cancer. This study suggests that clinicians should consider a range of symptoms, rather than just breathlessness, in planning outcomes for clinical trials. These results are important to inform patients about the potential benefits and duration of symptom improvement after therapeutic aspiration.
恶性胸腔积液（MPE）常见于晚期癌症患者。引流积液用于缓解症状并提高生活质量。
加深我们对治疗性胸腔穿刺抽液如何影响MPE患者症状及活动的理解。
在诺福克和诺维奇大学医院胸腔诊所就诊且确诊或疑似患有MPE的患者，在其诊断/治疗过程中参与了多达三次半结构化访谈。两名研究人员独立使用框架分析法对访谈进行分析。
16名患者参与。引流前报告的症状包括呼吸急促、咳嗽、胸痛、疲劳和厌食。这些症状影响了他们的活动，包括行走、弯腰和社交。患者描述了对潜在诊断的焦虑以及对过度依赖他人的恐惧。对引流结果的期望各不相同，一些人希望治愈，另一些人则希望有所改善。引流后，部分患者的呼吸急促、胸痛和咳嗽有所改善。他们报告感觉和睡眠更好，但疲劳和食欲不振仍然存在。穿刺抽液后参与者活动更积极，但改善持续时间仅为几天。尽管如此，患者仍认为该操作是值得的。
引流后整体健康状况和呼吸道症状有所改善，但全身症状并未改善。这可能是因为全身症状由潜在癌症引起。本研究表明，临床医生在规划临床试验结果时应考虑一系列症状，而不仅仅是呼吸急促。这些结果对于告知患者治疗性胸腔穿刺抽液后症状改善的潜在益处和持续时间很重要。
