MULTICENTER REVIEW OF TUNNELED PLEURAL CATHETER IMPLEMENTATION AND USE IN PATIENTS WITH MALIGNANT PLEURAL EFFUSIONS

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 02:15 pm - 03:15 pm PURPOSE: Malignant pleural effusions (MPEs) are common and often decrease patient quality of life. National and international guidelines on the management of MPEs recommend definitive strategies like tunneled pleural catheters (TPCs) or pleurodesis to palliate symptoms. We aimed to assess the temporal implementation and effects of TPC utilization for definitive pleural palliation in patients with MPEs in an international, multicenter review. METHODS: We performed a nine institution, international, retrospective review identifying 906 TPCs placed for MPE management from 2008-2015. These were further stratified by whether antineoplastic therapy was given or not within the month preceding TPC insertion and/or during drainage and were compared using the Mann-Whitney U test. RESULTS: The most frequent underlying primary cancers were lung (35%, 318) and breast (18%, 162). Annually, the rate of TPC insertions increased in frequency - 2008: 2% (20), 2009: 5% (48), 2010: 7% (60), 2011: 11% (102), 2012: 15% (132), 2013: 14% (129), 2014: 23% (205), 2015: 23% (210). Overall, the median duration from MPE diagnosis to TPC insertion was 34 (interquartile range [IQR] 13-92) days, with no trend in the median over the study timeframe: 2008: 27 (IQR 13-41), 2009: 37 (IQR 11-81), 2010: 19 (IQR 11-52), 2011: 36 (IQR 12-101), 2012: 35 (IQR 14-87), 2013: 45 (IQR 20-115), 2014: 35 (IQR 14-93), 2015: 30 (IQR 11-92). Thirty-three percent (300/906) of inserted TPCs were removed with an overall median time to removal of 84 (IQR 45-150) days. Median time to removal was similar in the 198 removed TPCs of 502 associated with antineoplastic therapy (85, IQR 47-150 days) versus the 102 removed of the 404 with no antineoplastic therapy (77, IQR 42-142 days); p=0.558. Of the 606 not removed, the overall median time to last contact/death was 62 (IQR 23-144) days; longer in those TPCs associated with antineoplastic therapy (64, IQR 27-155 days) compared to those with no antineoplastic therapy (60, IQR 21-112 days); p=0.040. CONCLUSIONS: Our data suggests that TPC usage for MPE palliation has increased each year over the study timeframe. In addition, implementation of TPCs for definitive pleural palliation appears to occur early in the disease course and likely provides prolonged symptomatic palliation. Antineoplastic therapy does not appear to be associated with a shortened time to TPC removal. CLINICAL IMPLICATIONS: Our data continues to support TPC use as a therapeutic option for MPEs and that early intervention is possible in MPE management. DISCLOSURES: Consultant relationship with VERAN Medical Technology Please note: $20001 - $100000 Added 11/28/2017 by Jason Akulian, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1-$1000 Added 11/28/2017 by Jason Akulian, source=Web Response, value=Travel Consultant relationship with Medtronic Please note: $5001 - $20000 Added 11/28/2017 by Jason Akulian, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Becton Dickinson Please note: $5001 - $20000 Added 11/28/2017 by Jason Akulian, source=Web Response, value=Honoraria Consultant relationship with Intuitive Surgical Please note: $1001 - $5000 Added 11/30/2017 by Jason Akulian, source=Web Response, value=Consulting fee No relevant relationships by Rachelle Asciak, source=Admin input No relevant relationships by Benjamin Bevill, source=Web Response No relevant relationships by Kevin Davidson, source=Web Response No relevant relationships by Ashley Delgado, source=Web Response No relevant relationships by Christopher Gilbert, source=Web Response No relevant relationships by Jed Gorden, source=Web Response Consultant relationship with Veracyte Please note: $5001 - $20000 Added 03/09/2018 by Hans Lee, source=Web Response, value=Consulting fee Consultant relationship with Veran Medical Please note: $20001 - $100000 Added 03/09/2018 by Hans Lee, source=Web Response, value=Grant/Research Support No relevant relationships by Justin Lewis, source=Web Response No relevant relationships by Fabien Maldonado, source=Web Response Consultant relationship with Olympus Please note: $1001 - $5000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria Consultant relationship with Boston Scientific Please note: $5001 - $20000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria Consultant relationship with Veran Please note: $5001 - $20000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Grant/Research Support Consultant relationship with Cook Please note: $1001 - $5000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria Consultant relationship with Rocket Medical UK Please note: $5001 - $20000 Added 03/12/2018 by Najib Rahman, source=Web Response, value=Salary No relevant relationships by Chakravarthy Reddy, source=Web Response No relevant relationships by Lance Roller, source=Web Response No relevant relationships by Henry Steer, source=Web Response Consultant relationship with Carefusion Please note: $1001 - $5000 Added 03/04/2018 by Momen Wahidi, source=Web Response, value=Consulting fee Removed 04/08/2018 by Momen Wahidi, source=Web Response Consultant relationship with Olympus Please note: $20001 - $100000 Added 04/08/2018 by Momen Wahidi, source=Web Response, value=Consulting fee Consultant relationship with Veran Please note: $1001 - $5000 Added 04/08/2018 by Momen Wahidi, source=Web Response, value=Consulting fee Consultant relationship with Broncus Please note: $1-$1000 Added 04/08/2018 by Momen Wahidi, source=Web Response, value=Consulting fee No relevant relationships by Howard West, source=Web Response No relevant relationships by Candice Wilshire, source=Web Response No relevant relationships by Amber Wright, source=Web Response Consultant relationship with Olympus Please note: $20001 - $100000 Added 02/12/2018 by Lonny Yarmus, source=Web Response, value=Grant/Research Support