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Pleurodesis for effusions in pediatric oncology patients at end of life

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Abstract

Background

Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients.

Objective

To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis.

Material and methods

Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3–21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses.

Results

Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge.

Conclusion

Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care.

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Acknowledgements

We thank graduate student Yi Ma for help with this analysis. This work was supported in part by Cancer Center Support (CORE) grant CA 21765 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Fredric A. Hoffer & Nikita Oigbokie

  2. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Michael L. Hancock & Shesh N. Rai

  3. Division of Nursing Research, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Pamela S. Hinds

  4. Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Bhaskar Rao

  5. Department of Radiology, R-5438, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Fredric A. Hoffer

Authors
  1. Fredric A. Hoffer
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  2. Michael L. Hancock
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  3. Pamela S. Hinds
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  4. Nikita Oigbokie
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  5. Shesh N. Rai
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  6. Bhaskar Rao
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Corresponding author

Correspondence to Fredric A. Hoffer.

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Hoffer, F.A., Hancock, M.L., Hinds, P.S. et al. Pleurodesis for effusions in pediatric oncology patients at end of life. Pediatr Radiol 37, 269–273 (2007). https://doi.org/10.1007/s00247-006-0392-y

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  • DOI: https://doi.org/10.1007/s00247-006-0392-y

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