Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study.

Seah, DS; Wilcock, A; Chang, S; Sousa, MS; Sinnarajah, A; Teoh, CO; Allan, S; Chye, R; Doogue, M; Hunt, J; Agar, M; Currow, DC

Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study.

Seah, DS Wilcock, A Chang, S

Sousa, MS Sinnarajah, A Teoh, CO Allan, S Chye, R Doogue, M Hunt, J Agar, M

Currow, DC

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: Palliative Medicine, 2022, 36, (9), pp. 1408-1417
Issue Date:: 2022-10

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Field	Value	Language
dc.contributor.author	Seah, DS
dc.contributor.author	Wilcock, A
dc.contributor.author	Chang, S https://orcid.org/0000-0003-0723-3192
dc.contributor.author	Sousa, MS
dc.contributor.author	Sinnarajah, A
dc.contributor.author	Teoh, CO
dc.contributor.author	Allan, S
dc.contributor.author	Chye, R
dc.contributor.author	Doogue, M
dc.contributor.author	Hunt, J
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119
dc.contributor.author	Currow, DC
dc.date.accessioned	2023-06-25T06:45:28Z
dc.date.available	2023-06-25T06:45:28Z
dc.date.issued	2022-10
dc.identifier.citation	Palliative Medicine, 2022, 36, (9), pp. 1408-1417
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/170866
dc.description.abstract	BACKGROUND: Paracentesis is commonly undertaken in patients with cancer-related ascites. AIM: To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting. DESIGN: Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner. SETTING/PARTICIPANTS: Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50. RESULTS: At T1 (n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak (n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation. CONCLUSION: Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	Palliative Medicine
dc.relation.isbasedon	10.1177/02692163221122326
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.subject.mesh	Aged
dc.subject.mesh	Ascites
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Neoplasms
dc.subject.mesh	Palliative Care
dc.subject.mesh	Paracentesis
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Paracentesis
dc.subject.mesh	Ascites
dc.subject.mesh	Palliative Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Neoplasms
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Ascites
dc.subject.mesh	Paracentesis
dc.subject.mesh	Palliative Care
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Paracentesis
dc.subject.mesh	Ascites
dc.subject.mesh	Palliative Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Neoplasms
dc.title	Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study.
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2023-06-25T06:45:26Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	9

Abstract:

BACKGROUND: Paracentesis is commonly undertaken in patients with cancer-related ascites. AIM: To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting. DESIGN: Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner. SETTING/PARTICIPANTS: Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50. RESULTS: At T1 (n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak (n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation. CONCLUSION: Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.

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http://hdl.handle.net/10453/170866