The First Therapeutic Intervention in Malignant Pleural Effusion Trial
| Status: | Completed |
|---|---|
| Conditions: | Lung Cancer, Pulmonary |
| Therapuetic Areas: | Oncology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | April 2009 |
| End Date: | December 2014 |
TIME1: A 2 X 2 Factorial Trial to Assess Whether Non-steroidal Anti-inflammatory Analgesics and Small-bore Chest Tubes Are Less Painful Than Opiate Analgesics and Large-bore Chest Tubes in Pleurodesis for Malignant Pleural Effusion.
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.
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.
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.
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.
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
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