The First Therapeutic Intervention in Malignant Pleural Effusion Trial

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.

Inclusion criteria

• 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
• Expected survival more than 1 month
• Written informed consent

Exclusion criteria

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