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Quality of life after interventions for malignant pleural effusions: a systematic review
  1. Parthipan Sivakumar1,
  2. Anita Saigal2 and
  3. Liju Ahmed3
  1. 1 Centre for Human & Applied Physiological Sciences, King's College London School of Medical Education, London, UK
  2. 2 Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
  3. 3 Department of Thoracic Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Parthipan Sivakumar, King's College London School of Medical Education, London, UK; deepan.sivakumar{at}


Background Malignant pleural effusion (MPE) results in breathlessness and impairment of health-related quality of life (HRQOL). This study reviews the existing literature on HRQOL following invasive interventions in MPE.

Methods Five electronic databases were systematically searched and assessed three times during the review process and last completed on 15 June 2018. We included all studies evaluating HRQOL outcomes for the following interventions: therapeutic thoracocentesis, talc slurry (TS) pleurodesis, indwelling pleural catheter (IPC) insertion and thoracoscopic talc poudrage (TTP) pleurodesis. Meta-analysis was not performed due to substantial heterogeneity in the published data.

Results 17 studies were included in the review reporting HRQOL outcomes in 2515 patients. TTP, TS and IPC were associated with modest but inconsistent improvements in HRQOL up to 12 weeks. No intervention was significantly different from another in HRQOL outcomes at any time point. The attrition to follow-up was 48.3% (664/1374) at 3 months. The overall quality of studies was inadequate.

Conclusion TTP, TS and IPC seem to improve HRQOL in MPE over 4–12 weeks, but there are insufficient longer term data due to high attrition rates. Evidence on the most effective treatment strategy is limited by the small number of randomised or comparative studies.

Trial registration number CRD42016051003.

  • pleural effusion
  • quality of life
  • talc pleurodesis
  • thoracoscopy

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  • Contributors All authors included in the paper fulfil the criteria for authorship. PS, AS and LA were involved in project conception, drafting and final approval of the manuscript. PS and AS conducted abstract review and data analysis. LA reviewed the methodology, analysis and presentation of the results. PS is the guarantor.

  • Funding LA and PS have received funding from CareFusion for the OPTIMUM trial (UKCRN 19615), and PS and LA have received funding from Rocket Medical UK for the SINE Study (UKCRN 34053).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.