Sage Journals: Discover world-class research

Abstract

Background:

Paracentesis is commonly undertaken in patients with cancer-related ascites.

Aim:

To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting.

Design:

Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner.

Setting/participants:

Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50.

Results:

At T1 (n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak (n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation.

Conclusion:

Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.

Keywords

Ascites neoplasms drainage paracentesis palliative care

Get full access to this article

View all access options for this article.

References

Parsons

Lang

Steele

RJC

. Malignant ascites: a 2-year review from a teaching hospital. Eur J Surg Oncol 1996; 22: 237–239.

Becker

Galandi

Blum

. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer 2006; 42: 589–597.

Husain

Bezjak

Easson

. Malignant ascites symptom cluster in patients referred for paracentesis. Ann Surg Oncol 2010; 17: 461–469.

Eitan

Raban

Tsoref

, et al. Malignant ascites: validation of a novel ascites symptom mini-scale for use in patients with ovarian cancer. Int J Gynecol Cancer 2018; 28: 1162–1166.

Gottumukkala

Prabhakar

Hemingway

, et al. Disparities over time in volume, day of the week, and patient complexity between paracentesis and thoracentesis procedures performed by radiologists versus those performed by nonradiologists. J Vasc Interv Radiol 2019; 30: 1769–1778.e1.

Duszak

Jr Chatterjee

Schneider

. National fluid shifts: fifteen-year trends in paracentesis and thoracentesis procedures. J Am Coll Radiol 2010; 7: 859–864.

McNamara

. Paracentesis–an effective method of symptom control in the palliative care setting? Palliat Med 2000; 14: 62–64.

Easson

Bezjak

Ross

, et al. The ability of existing questionnaires to measure symptom change after paracentesis for symptomatic ascites. Ann Surg Oncol 2007; 14: 2348–2357.

Stukan

. Drainage of malignant ascites: patient selection and perspectives. Cancer Manag Res 2017; 9: 115–130.

10.

Ross

Kessler

Clair

, et al. Sonographically guided paracentesis for palliation of symptomatic malignant ascites. AJR Am J Roentgenol 1989; 153: 1309–1311.

11.

Currow

Rowett

Doogue

, et al. An international initiative to create a collaborative for pharmacovigilance in hospice and palliative care clinical practice. J Palliat Med 2012; 15: 282–286.

12.

Charlson

Pompei

Ales

, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

13.

Abernethy

Shelby-James

Fazekas

, et al. The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]. BMC Palliat Care 2005; 4: 7.

14.

Masso

Allingham

Banfield

, et al. Palliative care phase: inter-rater reliability and acceptability in a national study. Palliat Med 2015; 29: 22–30.

15.

U.S. Department of Health and Human Services, National Institutes of Health and National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0. 2010.

16.

Rosenberg

. Palliation of malignant ascites. Gastroenterol Clin North Am 2006; 35: 189–199, xi.

17.

Harris

Taylor

Minor

, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208.

18.

Currow

Vella-Brincat

Fazekas

, et al. Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide. J Palliat Med 2012; 15: 1071–1075.

19.

Sanderson

Quinn

Agar

, et al. Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain. BMJ Support Palliat Care 2015; 5: 273–280.

20.

THM

LeBlanc

Eastman

, et al. The prospective evaluation of the net effect of red blood cell transfusions in routine provision of palliative care. J Palliat Med 2017; 20: 1152–1157.

21.

Benchimol

Smeeth

Guttmann

, et al. The REporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med 2015; 12: e1001885.

22.

Cho

Jensen

Reierson

, et al. Recommendations on the use of ultrasound guidance for adult abdominal paracentesis: a position statement of the Society of Hospital Medicine. J Hosp Med 2019; 14: E7–E15.

23.

White

Reid

Vickerstaff

, et al. Specialist palliative medicine physicians and nurses accuracy at predicting imminent death (within 72 hours): a short report. BMJ Support Palliat Care 2020; 10: 209–212.

24.

White

Reid

Harris

, et al. A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLoS One 2016; 11: e0161407.

25.

National Institute for Health and Care Excellence. PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites. Appl Health Econ Health Policy 2012; 10: 299–308.

26.

Christensen

Wildgaard

. Permanent catheters for recurrent ascites—a critical and systematic review of study methodology. Support Care Cancer 2016; 24: 2767–2779.

27.

Fleming

Alvarez-Secord

Von Gruenigen

, et al. Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manag 2009; 38: 341–349.

28.

Rosenberg

Courtney

Nemcek

Jr , et al.Comparison of percutaneous management techniques for recurrent malignant ascites. J Vasc Interv Radiol 2004; 15: 1129–1131.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.02 MB