Outcomes/Effectiveness Research

Talc should be the agent of choice when treating fluid buildup around the lungs from advanced cancer

Buildup of fluid around the lungs—pleural effusion—is common among patients with advanced cancer. The fluid buildup causes breathlessness and immobility in cancer sufferers during the last months of life. However, prompt, well-judged, and skilled management of the effusion via a procedure called pleurodesis can alleviate the breathlessness and improve quality of life for cancer patients. In pleurodesis, an irritating substance is infused into the chest cavity to create inflammation, which tacks the membranes around the lung together and prevents buildup of fluid in the space between membranes. This is accomplished using video-assisted thoracoscopic surgery or at the bedside through a chest tube.

Talc appears to be effective and should be the first agent of choice for pleurodesis, concludes a new study. Researchers found that infusing talc into the lungs via thoracoscopic surgery might be associated with fewer recurrences of effusions compared with bedside talc slurry. However, when thorascopy is unavailable, bedside talc pleurodesis has a high success rate and can be a comparable option.

Artyom Sedrakyan, M.D., Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), and colleagues systematically reviewed 46 studies that included 2,053 patients with malignant pleural effusions, to examine the effectiveness of pleurodesis. They focused on the choice of agents, route of delivery, and other strategies to improve outcomes. Talc tended to be associated with fewer recurrences when compared with bleomycin and, with more uncertainty, to tetracycline. Tetracycline (or doxycycline) was not superior to bleomycin. When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a 79 percent reduction in recurrence but the evidence was limited.

See "The evidence on the effectiveness of management of malignant pleural effusion: A systematic review," by Carol Tan, Dr. Sedrakyan, John Browne, and others, in the May 2006 European Journal of Cardio-thoracic Surgery 29, pp. 829-838. Reprints (AHRQ Publication No. 06-R071) are available from the AHRQ Publications Clearinghouse.

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