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Tunneled pleural catheter use for pleural palliation does not increase infection rate in patients with treatment-related immunosuppression

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Abstract

Purpose

Concerns for infections resulting from antineoplastic therapy-associated immunosuppression may deter referral for symptom palliation with a tunneled pleural catheter (TPC) in patients with malignant/para-malignant pleural effusions (MPE/PMPE). While rates of TPC-related infections range from 1 to 21%, those in patients receiving antineoplastic therapy with correlation to immune status has not been established. We aimed to assess TPC-related infection rates in patients on antineoplastic therapy, determine relation to immune system competency, and assess impact on the patient.

Methods

Patients with a MPE/PMPE undergoing TPC management associated with antineoplastic therapy, from 2008 to 2016, were reviewed and categorized into those with an immunocompromised versus immunocompetent immune status.

Results

Of the 150 patients, a TPC-related infection developed in 13 (9%): pleural space in 11 (7%) and superficial in 2 (1%). Ninety-three percent (139/150) were identified to be immunocompromised during their antineoplastic therapy. No difference in TPC-related infections was seen in patients with an immunocompromised (9%, 12/139) versus immunocompetent status (9%, 1/11); p = 0.614. The presence of a catheter-related infection did not negatively impact overall survival over a median follow-up of 144 days (interquartile range 41–341); p = 0.740.

Conclusions

These results suggest that antineoplastic therapy may not significantly increase the overall risk of TPC-related infections, as the rate remains low and comparable to rates in patients not undergoing antineoplastic therapy. Regardless of immune status, the presence of a catheter-related infection did not negatively impact overall survival. These results should reassure clinicians that the need to initiate antineoplastic therapy should not delay definitive pleural palliation with a TPC.

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Funding

This research was supported by The Center for Lung Research in Honor of Wayne Gittinger.

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Authors and Affiliations

  1. Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA

    Candice L. Wilshire, Christopher R. Gilbert, Brian E. Louie, Ralph W. Aye, Alexander S. Farivar, Eric Vallières & Jed A. Gorden

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  1. Candice L. Wilshire
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  2. Christopher R. Gilbert
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  3. Brian E. Louie
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  4. Ralph W. Aye
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  5. Alexander S. Farivar
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  6. Eric Vallières
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  7. Jed A. Gorden
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Corresponding author

Correspondence to Jed A. Gorden.

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The authors declare that they have no conflicts of interest.

Additional information

Oral presentation at:

19th World Congress of the World Association for Bronchology and Interventional Pulmonology

Interventional pulmonology in the management of pleural diseases session

Florence, Italy

May 9, 2016

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Wilshire, C.L., Gilbert, C.R., Louie, B.E. et al. Tunneled pleural catheter use for pleural palliation does not increase infection rate in patients with treatment-related immunosuppression. Support Care Cancer 26, 1525–1531 (2018). https://doi.org/10.1007/s00520-017-3989-9

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  • DOI: https://doi.org/10.1007/s00520-017-3989-9

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