Author of

• 14704

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  P2.11 - Poster Session/ Palliative and Supportive Care (ID 230)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Palliative and Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 14718

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    P2.11-014 - Tunneled Pleural Catheters Are Safe in the Setting of Chemotherapy and Immune Suppression (ID 3075)

    09:30 - 09:30  |  Author(s): A.S. Farivar
    • Abstract
    • Slides

    Background:
    The reported rate of tunneled pleural catheter (TPC)-related infections in patients on chemotherapy ranges from 4-20%. Thus, infection is often cited as a contraindication to placement of a TPC in patients with recurrent symptomatic malignant/para-malignant pleural effusions (MPE/PMPE) receiving chemotherapy. Delay in the definitive management of such pleural effusions can result in an increased number of procedures, progressive symptoms and decreased independence in patients with advanced disease. Current data does not directly associate TPC-related infections to a patient’s immune status on chemotherapy. We aim to correlate catheter-related infections to immune system competency around the time of chemotherapy.
    
    Methods:
    A review of patients with MPE/PMPEs managed with a TPC from 2009-2014 was conducted. We identified 182 patients, of which 109 had chemotherapy within 1 month of TPC insertion or at any time during TPC drainage. An immunocompromised state was defined as the presence of leukopenia [white blood cells (WBC) <4 th/mm[3]] when a differential count was unavailable; or lymphopenia [lymphocytes <1 th/mm[3]], and/or neutropenia [absolute neutrophil count (ANC) <1.5 th/mm[3]]. A pleural infection was defined as the presence of a positive gram stain/culture of pleural fluid.
    
    Results:
    Seventy-three (67%) of the 109 patients were identified to be immunocompromised. Only 5 (7%) of the 73 developed a pleural infection. All 5 (100%) received antibiotic treatment. Two of the 5 (40%) pleurodesed and underwent catheter removal, 2 (40%) maintained effective catheter drainage, while 1 (20%) underwent TPC removal and replacement with a pigtail catheter. Of the 5 patients, 4 (80%) demised at a median of 5 months (IQR, 3-8) following the pleural infection. All deaths were considered related to progression of malignant disease and not a consequence of infection. One patient is alive and still undergoing drainage.
    
    Conclusion:
    These preliminary results suggest that chemotherapy and immune suppression do not significantly increase the risk of TPC-related infections as the rate is low and comparable to immunocompetent patients. Chemotherapy should not delay the decision to definitely palliate patients with TPCs in the setting MPE/PMPEs.
    
    

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