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Effect of paracentesis on the survival of patients with terminal cancer and ascites: a propensity score–weighted analysis of the East Asian Collaborative Cross-cultural Study to Elucidate the Dying Process

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Abstract

Purpose

Paracentesis is among the most widely utilized treatments for malignant ascites (MA). However, paracentesis in patients with MA has the potential to be associated with life-shortening effects. Thus, this study aimed to investigate whether paracentesis affected the duration of survival in such patients.

Methods

We performed a post hoc analysis of a prospective multicenter observational study investigating the dying process and end-of-life care in patients with terminal cancer, admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used inverse probability of treatment weighting (IPTW) to control for baseline covariates between groups.

Results

Among the 1896 initially enrolled patients, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The primary tumor site was the pancreas (51.9%, n = 295), followed by the gastrointestinal tract (22.7%, n = 129). Non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16–25) and 12 days (95% CI: 11–13) in the paracentesis and non-paracentesis groups, respectively (hazard ratio [HR]: 0.69, 95% CI: 0.54–0.88; p = 0.003). The IPTW-adjusted median survival durations were 22 (95% CI: 16–25) and 16 days (95% CI: 12–22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64–1.24; p = 0.492). No serious adverse events occurred in the paracentesis group.

Conclusions

Paracentesis does not negatively affect the survival of patients with cancer and MA and can be a standard treatment in palliative care settings.

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Data availability

The datasets generated during the current study are not publicly available due to ethical restrictions but are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

We highly appreciate the participation of the patients and their families, and the cooperation of members of the East Asian Collaborative Cross-cultural Study to Elucidate the Dying Process (EASED) study group.

Funding

This work was supported by Grant-in-Aid from the Japanese Hospice Palliative Care Foundation and JSPS KAKENHI (Grant Number JP20K16567).

Author information

Authors and Affiliations

  1. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Ken Masuda

  2. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Hiroto Ishiki & Koji Amano

  3. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan

    Naosuke Yokomichi

  4. Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai-shi, Miyagi, 980-8574, Japan

    Takuhiro Yamaguchi

  5. Department of Palliative Care, Japanese Red Cross Medical Center, 4-1-22 Hiro, Shibuya-ku, Tokyo, 150-8935, Japan

    Tetsuya Ito

  6. Division of Palliative Care, Konan Medical Center, 1-5-16 Kamoshigawara, Higashinada-ku, Kobe-shi, Hyogo, 658-0064, Japan

    Hana Takatsu & Takashi Yamaguchi

  7. Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, 1 Katsuragosho-machi, Saikyo-ku, Kyoto, 658-0064, Japan

    Shuji Hiramoto

  8. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan

    Toshihiro Yamauchi

  9. Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan

    Takashi Kawaguchi

  10. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan

    Masanori Mori

  11. Palliative Care Department, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Yosuke Matsuda

Authors
  1. Ken Masuda
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  2. Hiroto Ishiki
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  3. Naosuke Yokomichi
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Contributions

KM, HI, TI, NY, TK, and MM made substantial contributions to the conception and design of the study, acquisition of data, and data analysis. KM and HI drafted the manuscript and approved the submitted version. HI made substantial contributions to the study design and revision of the manuscript. NY and TY accessed and verified the underlying study data and contributed to data analysis and interpretation. TI, HT, KA, SH, TY, YM, and TY contributed to the conception and study design, data collection and assembly, data interpretation, writing of the manuscript, and critical revision of the manuscript for important intellectual content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Hiroto Ishiki.

Ethics declarations

Ethics approval

The EASED study was performed in accordance with the ethical standards of the Helsinki declaration and the ethical guidelines for epidemiological research presented by the Ministry of Health, Labour and Welfare in Japan. The study protocol was reviewed and approved by the local institutional review boards of all participating institutions.

Consent to participate

Japanese law does not require individual informed consent from participants in a non-invasive observational trial. Therefore, we used an opt-out method rather than acquiring written or oral informed consent.

Consent for publication

Not applicable.

Conflict of interest

Dr. Ishiki reports personal fees from Mundipharma, Morinaga Clinico, Merck Serono, and Guerbet Japan and non-financial support from Shionogi outside of the submitted work; Dr. Masuda reports personal fees from Chugai and AstraZeneca outside of the submitted work. All other authors state that they have no conflicts of interest.

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Masuda, K., Ishiki, H., Yokomichi, N. et al. Effect of paracentesis on the survival of patients with terminal cancer and ascites: a propensity score–weighted analysis of the East Asian Collaborative Cross-cultural Study to Elucidate the Dying Process. Support Care Cancer 30, 6233–6241 (2022). https://doi.org/10.1007/s00520-022-07057-8

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