The First Therapeutic Intervention in Malignant Pleural Effusion Trial

Not Applicable

Completed

• Conditions: Malignant Pleural Effusion; Pleural Effusion
• Interventions: Other: Large bore chest drain + NSAID based analgesic regimen; Other: Large bore chest drain + opiate based analgesic regimen; Other: Small bore chest drain + opiate based analgesic regimen; Other: Small bore chest drain + NSAID based analgesic regimen

• Registration Number: NCT00896285
• Lead Sponsor: University of California, Davis

Brief Summary

Fluid caused by cancer cells may accumulate in the lining of the lung. Draining the fluid with a chest tube may relieve pain and shortness of breath. To stop the fluid from coming back again, patients are given a medicine (talc) into the chest drain to seal up the space around the lung. This procedure is known as pleurodesis. This sometimes causes pain and discomfort, and the investigators do not know the best way of preventing this.

The investigators hope to find the best way to prevent pain during pleurodesis.

Detailed Description

Patients with metastatic cancer often have fluid collecting around the lung as a result of cancer cells spreading to the membranes adjacent to the lung (malignant pleural effusion). The standard way of treating this condition, which may cause unpleasant symptoms such as breathlessness and cough, is to drain the fluid off and then seal the cavity, using a drug (talc) given into the chest drain. Talc causes inflammation in the lining of the lung and chest wall, sticking the two surfaces together and preventing fluid from recurring. This procedure is often very painful; the pain may be partly related to the size of the chest tube used and the type of analgesia taken by the patient during the procedure. Reducing the amount of pain associated with this procedure would be a substantial benefit for patients undergoing this procedure.

This trial is looking at which of two different drug regimens is more effective in preventing pleurodesis pain, and whether the size of chest tube influences pain. It will also address whether either of these influences success rate of pleurodesis.

We hope to learn whether the size of chest drain or the type of pain medication given (ibuprofen or morphine) influences the amount of pain felt after the pleurodesis procedure. We hope to find the best way of preventing pain during this procedure.

Study Timeline

• Study Start: 2009-04
• Study First Submitted: 2009-05-07
• Study First Submitted QC: 2009-05-08
• Study First Posted: 2009-05-11
• Primary Completion: 2014-12
• Study Completion: 2014-12
• Status Verified: 2015-07
• Last Update Submitted: 2015-07-16
• Last Update Posted: 2015-07-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 4

Inclusion Criteria

1. Clinically confident diagnosis of malignant pleural effusion requiring pleurodesis. The diagnosis may be established by one of:

   • Histologically proven pleural malignancy OR
   • Typical features of pleural malignancy seen on direct vision during thoracoscopy OR
   • Pleural effusion in the context of histologically proven cancer elsewhere

2. Expected survival more than 1 month

3. Written informed consent

Exclusion Criteria

1. Age < 18 years
2. Primary lymphoma or small cell lung carcinoma
3. Patients who are pregnant or lactating
4. Inability to give informed consent
5. History of GI bleeding or of untreated peptic ulceration
6. Known sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs)/opiates/acetaminophen
7. Hypercapnic respiratory failure
8. Known intravenous drug abuse
9. Severe renal or liver disease
10. Known bleeding diathesis
11. Warfarin therapy
12. Current or recent (within 2 weeks) corticosteroid steroid therapy

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
1	Large bore chest drain + NSAID based analgesic regimen	-
3	Large bore chest drain + opiate based analgesic regimen	-
4	Small bore chest drain + opiate based analgesic regimen	-
2	Small bore chest drain + NSAID based analgesic regimen	-

Primary Outcome Measures

Name	Time	Method
Pleurodesis success at 3 months post randomization (time to relapse of pleural effusion)	3 months
An average pain score over 72 hours post pleurodesis for malignant pleural effusion	72 hours

Secondary Outcome Measures

Name	Time	Method
Presence of chronic chest pain on the side of the pleurodesis	6 months

Trial Locations

Locations (1)

UC Davis Medical Center; 🇺🇸 Sacramento, California, United States