Advances in therapeutics have been slow, with more growth in the last 15 years. Despite its longstanding recognition, management has remained predominantly palliative in nature. 1 Although there are no studies to date documenting the rate of hospitalizations for all patients with MPE, clinical experience suggests that a vast majority of patients with MPE seek medical care and are often managed for their symptoms in hospital. 2, 3 A recent retrospective analysis using the Healthcare Cost and Utilization Project National Inpatient Sample database identified 126,825 hospital admissions for MPE in 2012.

1 It is estimated to affect 150,000 people each year in the US and over 100,000 people in Europe. Malignant pleural effusion (MPE) affects many patients around the world and has significant morbidity and mortality associated with it. Keywords: malignant pleural effusion, therapeutics, cost-effectiveness, quality of life In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Erika Penz, 1 Kristina N Watt, 1 Christopher A Hergott, 2 Najib M Rahman, 3 Ioannis Psallidas 3ġDivision of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, 2Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada 3Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UKĪbstract: Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality.

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