Malignant pleural mesothelioma (MPM) kills one person every four hours in
the UK and every 12 hours in Australia. The global incidence of MPM continues to rise.
MPM has no cure and symptom control is the key. Most MPM patients suffer from a
pleural effusion; proficient care of malignant effusions and the associated breathlessness
is essential to all MPM programs. MPM has unique characteristics in its pathobiology,
clinical presentation and disease course that must be distinguished from those
associated with metastatic cancers to the pleura. Recognizing these differences, e.g. the
longer survival of MPM patients and higher risk of procedural tract metastases, are
important. Patients with MPM-related pleural effusions are more likely to require
definitive interventions for pleural fluid control, such as pleurodesis or indwelling
pleural catheter (IPC) placement. One-third of MPM patients will fail talc pleurodesis,
whether it is delivered by poudrage or slurry. IPC is well accepted as a treatment in
patients with a trapped lung or when pleurodesis failed. Increasing evidence support the
use of IPC instead of pleurodesis. However, effective use of IPC involves appropriate
aftercare and optimal management of potential complications. Breathlessness in MPM
is often multi-factorial; optimizing care of concurrent (non-effusion) causes of
breathlessness is paramount. MPM cohorts are heterogeneous and disease courses can
vary; only ~50% will require definitive therapies for pleural effusion management.
Developing a personalized management plan based on predictions of survival,
symptomatic response to pleural fluid drainage and effusion recurrence is the goal of
contemporary research.
Keywords: Breathlessness, indwelling pleural catheter, malignant effusion,
pleural, pleurodesis, procedure-tract metastasis, talc.
