BACKGROUND: Patients with malignant pleural effusions (MPEs) experience breathlessness and poor survival. Breathlessness is associated with poor survival in other conditions.
RESEARCH QUESTION: Is breathlessness, measured using a visual analogue scale for dyspnoea (VASD), associated with survival in patients with MPE?
STUDY DESIGN AND METHODS: Individual patient data from five randomized controlled trials of 553 patients undergoing interventions for MPE were analysed. VASD was recorded at baseline and daily post-intervention. Patients were followed up until death or end of trial. Univariate and multivariable Cox-regression were used to identify factors associated with survival.
RESULTS: Baseline VASD was significantly associated with worse survival, with a hazard ratio of 1.10 (95% CI 1.06-1.15) for a 10mm increase in VASD. On multivariable regression, it remained a significant predictor of survival. Mean 7 day VASD and mean total VASD were also predictors of survival (mean 7 day VASD, HR 1.26 (95% CI 1.19-1.34), total VASD, HR 1.25 (95% CI 1.15-1.37)). Other predictors of survival were serum C reactive protein level and tumour type. Previous treatment with chemotherapy, performance status, pleural fluid lactate dehydrogenase, serum albumin, haemoglobin, serum neutrophil:lymphocyte ratio and size of effusion were associated with survival on univariate but not multivariable analysis.
INTERPRETATION: Breathlessness, measured using VASD at baseline and post-procedure, is a predictor of survival in patients with MPE.