Chemical Pleurodesis in Palliative Setting: A Brunei Experience

Abstract

BACKGROUND Malignant pleural effusion is typically a sign of an aggressive and advanced disease, generally with a short life expectancy. This causes a lot of burdens symptomatically to patients with advanced malignancy. Hence, a lot of patients are made known early to palliative service to help optimize patients’ quality of life. One of the procedures to help prevent the recurrence of symptomatic malignant pleural effusion is bedside chemical pleurodesis following thoracocentesis. The aim of this audit is to assess the efficacy and safety of carrying out the above procedure in a palliative setting. METHOD Retrospective electronic records of patients were reviewed from January 2020 until December 2021. Malignant pleural effusion was confirmed by cytological assessment of pleural fluid following chest tube drainage. Chemical pleurodesis was done by pleural fluid instillation of bleomycin. RESULTS Eighteen patients were included, with 6 male cases and 12 female cases. The mean age was 69.4 years, with 61% of the patients suffering from lung malignancy. Complete response is seen in 44.4% and partial response is seen in 22.2%. The failure rate is 33.3%. The complications were minimal with only 5.6% of patients having fever and 11.1% having pleuritic pain. CONCLUSIONS The audit shows that bedside chemical pleurodesis performed by a palliative team is as efficacious and safe as when it is performed by other specialists. It helps improve the symptoms in 66% of our patients and thus improve their quality of life.